Adverse Reactions to Ketogenic Diets: Caution Advised

About Dr. Sarah Ballantyne, PhD

Award-winning public speaker, New York Times bestselling author and world-renowned health expert, Dr. Sarah Ballantyne, PhD (aka The Paleo Mom) believes the key to reversing the current epidemics of chronic disease is scientific literacy. She creates educational resources to help people regain their health through diet and lifestyle choices informed by the most current evidenced-based scientific research.

As the ketogenic diet gains popularity, it’s important to have a balanced discussion regarding the merits of this diet. Let me emphasize right out of the gate that this is not a diet without merits (excuse the double negative); in fact, it has significant therapeutic potential for some clinical pathologies. However, it is also a diet with inherent risk, as evidenced by the extensive list of adverse reactions reported in the scientific literature—and this has not yet been a thorough enough part of the public discussion on ketogenic diets.

Typical ketogenic diet macronutrient ratios

This articles is inclined toward balancing the discussion of the pros and cons of this high-fat, low-carb, low/moderate-protein diet. My interest in this topic stems from concerns I have over its general applicability and safety, simultaneous with its growing popularity. I feel a moral and social obligation to share what I understand of these diets, from my perspective as a medical researcher. The dangers of a ketogenic diet was, in fact, the topic of my keynote presentation at Paleo F(x) this year (links to video will be provided once available). This series of articles will share the extensive research that I did in preparation for this presentation, including all of the topics covered during my talk as well as several topics that I didn’t have time to discuss (also see the free PDF Literature Review at the bottom of this post).

For every anecdotal story of someone who has regained their health with a ketogenic diet, there’s a counterpoint story of someone who derailed their health with an identical diet. I’m not here to trade anecdotes. I’m here to cite a collection of scientific papers, including results from clinical trials, case studies, and mechanistic studies that show a potential dark side to the ketogenic diet. And that dark side is one that everyone needs to be aware of while they perform their own individual cost-benefit analysis to decide whether this dietary strategy is worth attempting for them.

The Thyroid Reset Summit

Exhausted? Brain fog? Struggling with weight gain? You’re not alone. Still the MOST common and MOST misdiagnosed autoimmune issues, thyroid conditions continue to impact tens of millions worldwide.

Join me to gain the best secrets and practical strategies for healing! Don’t miss this online educational summit from March 4-10, 2019.

Where Do Ketogenic Diets Come From?

The origins of the ketogenic diet were the observations of Hippocrates in 500BC that fasting could reduce and even cure epileptic seizures (fasting is also a ketogenic state, more on that in a future post). However, it wasn’t until 1911 that the first scientific study on starvation as epilepsy treatment was published. Two French doctors, Guelpa and Marie, observed that a 4-day fast decreased seizure frequency in 20 epileptic children and adults, which led to “La cure du Dr. Guelpa”, a prescribed treatment for epilepsy that consisted of fasting followed by a very limited vegetarian diet. Dr. Hugh Conklin popularized fasting (three days to three weeks) as a way to cure numerous illnesses, including epilepsy. The banner was taken up in 1921 by endocrinologist Dr. H. Rawle Geyelin, who was the first to document cognitive improvement resulting from fasting in a scientific study performed on 26 epileptic patients.

Dr. Conklin’s work hit the news!

Fasting has one very important barrier to rampant clinical use: it’s not sustainable. You can’t starve for the rest of your life and expect it to last very long. In 1921, Drs. Stanley Cobb and W.G. Lennox became the first to observe that control of seizures by fasting occurs via a change in body metabolism that can be induced either by absence of food or by a very low carbohydrate intake. And this observation led to the birth of a form of nutritional starvation, the ketogenic diet, a term coined by Dr. Russell Wilder who developed the diet as an alternative to fasting and demonstrated its comparable effectiveness in epilepsy. Dr. Wilder observed that the diet produced high levels of ketone bodies in the blood and hypothesized that a high fat, low carbohydrate diet would mimic the anticonvulsant effects of fasting because limited glucose supply would force fat to be metabolized into ketones, which could then be used as an alternative fuel by the brain (this hypothesis took decades to prove, and the more detailed mechanisms remain largely a mystery). In 1925, Dr. Mynie Peterman, calculated the exact formula for nutritional ketosis, a daily diet comprised of: 10 – 15 grams of carbohydrate, 1 gram per kilogram of bodyweight of protein, and the rest fat (a macronutrient formula that is still within the narrow range used in various ketogenic diet variations today) . In the earliest epilepsy studies, calories were restricted to 75% of daily allowance, although the need for calorie-restriction concurrent with ketogenic diets for the treatment of epilepsy has since been disproved.

Research into ketogenic diets went through many ups and downs over the decades that followed. Every time a new anticonvulsant drug for epilepsy was developed, interest in ketogenic diets waned under the presumption that it’s easier, and more tolerable, to take a pill every day compared to a severely restrictive diet. However, interest was rekindled in the wake of professional and public recognition subsequent to: the popularity of the Atkins’ Diet Revolution; a Dateline report featuring a 2-year-old Charlie Abrahams whose intractable seizures are successfully stopped after he adopted a ketogenic diet; the creation of The Charlie Foundation which disseminates informational ketogenic diet videos to doctors and dieticians; and the movie Do No Harm. Since the late-1990s, research into ketogenic diets has expanded, including a series of long-term ketogenic diet studies for refractory epilepsy (epilepsy that did not respond to anticonvulsant drugs) and investigation of a variety of other applications such as weight loss, tumor shrinkage, and neurodegenerative diseases like Alzheimer’s.

Adverse Reactions to Ketogenic Diets

As the list of health conditions that may be at least partially alleviated by ketogenic diets increase (and which currently includes epilepsy, Alzheimer’s, Parkinson’s, Autism, traumatic brain injury, bipolar disease, PCOS, cancer, obesity, and diabetes), so too does a body of literature pointing to common side effects and potential adverse reactions.

Adverse reactions to a ketogenic diet have been reported in the scientific literature. Yes, even including well-designed clinical trials performed and published very recently. In fact, the intolerability of side effects and adverse reactions is the primary reason for trial participants to drop out of clinical trials (other reasons for trial drop-outs include ineffectiveness of the diet, and that the diet is too hard to follow).

Adverse reactions are not the same thing as side effects. An adverse reaction is an, unwanted/unexpected and dangerous reaction to a therapeutic agent. In contrast, a side effect is a secondary, typically undesirable effect of a therapeutic agent. More simplistically, side effects are minor and adverse reactions are not. Side effects are typically what are reported in shorter-term studies, where as both side effects and adverse reactions are reported in the long-term ketogenic dietstudies (typically 6 months to 2 years, but any study that allows for keto-adaptation, which takes up to a month, can be considered long-term). This article is not a discussion regarding side effects, the list of which has some overlap with the list of adverse reactions (for example common side effects include minor gastrointestinal symptoms). This article is to draw attention to the documented adverse reactions, which include:

That’s a long list. A long list of not-good things. And did you catch that last one? Five scientific papers have reported deaths as an adverse effect from long-term ketogenic diets (here’s the citations: Stewart, et al., 2001, Kang, et al., 2004, Kang, et al., 2005, Bank, et al., 2008, Suo, et al., 2013 and make sure to check out the free PDF download of my Literature Review at the bottom of this post which contains details on all of the papers reporting adverse reactions). Two of these papers are case studies, and the other three are papers derived from two separate clinical trials, all studies in epileptic children. Some of the deaths can be attributed to extra complications from secondary conditions or accidents that befell the child during the course of the clinical trial; however, other deaths—most typically from severe infection or heart disease—are attributed directly to long-term ketosis.

The Relevance of Adverse Reactions

I believe the potential for adverse reactions is important information for people to know when they are weighing a ketogenic diet versus other diets or therapeutic options. But, that doesn’t mean that everyone need avoid ketogenic diets. It’s a question of weighing the pros and cons for each individual. And certainly some of the above adverse reactions can be prevented with careful choice of foods and/or targeted supplementation (such as nutrient deficiency). And it’s important to emphasize that the above list of adverse events also points to a long list of tests that can be performed regularly by a supervising health professional to monitor for any potential detriment in the event that there are compelling reasons to undertake a ketogenic diet.

When you read reports expounding on the benefits of a ketogenic diet, purporting that there is no risk involved or at least no risk for most of us, the origin of this dogma is either a selective reading of the science (which may be unintentional—I’m not a conspiracy theorist) or a bias-motivated dismissal of any scientific studies to the contrary of this narrative. For example, I’ve heard these adverse reactions described as “minor” and “transient” or attributable in some way to “people doing keto wrong”, statements that are not actually substantiated by the scientific literature (although, those might be fair appraisals of side effects from short-term studies). As a second example, I’ve heard declarations that the long-term ketogenic diet studies in children with refractory epilepsy are irrelevant since these children are not robust, heathy kids and many of them (although certainly not all) are simultaneously taking anticonvulsant drugs while following a ketogenic diet to mitigate severe, frequent seizures. Because the overwhelming majority of the long-term ketogenic diet studies have thus far been performed in the context of epilepsy, this is the field of research that has most thoroughly reported adverse reactions. Certainly, these kids belong to a more sensitive population (why documented deaths as a result of adverse reactions to a ketogenic diet have occurred almost exclusively in epileptic children), but that doesn’t mean that these reports don’t provide extremely useful information, or a warning worth heeding (another double negative!). After all, it’s not typically the robust healthy person who experiments with ketogenic diets to improve their health—and while death is probably very unlikely, the potential harm to other body systems (cardiovascular, immune, endocrine, digestive) remains.

The Need For More Science

The body of scientific literature on ketogenic diets is surprisingly sparse when you consider the therapeutic applications of this diet have been in effect for nearly a century. A mere 1592 scientific papers are returned by PubMed (the US National Library of Medicine and National Institutes of Health online medical research database) with the search term “ketogenic diet”. It’s not that other diets are more thoroughly researched per se, but certainly other therapeutic strategies to mitigate disease, the most relevant example being anticonvulsant drugs for epilepsy (c.f. PubMed returns 135282 scientific papers with the search term “anticonvulsant drugs”) are monumentally better understood before being approved for use.

Frankly, research is just beginning to scratch the surface in terms of understanding how ketogenic diets work to reduce seizures in epilepsy or to provide the other documented benefits. Why is that important? Because the extensive list of documented side effects and adverse reactions indicate that the positive health effects of a ketogenic diet comes at a cost, one that may not be acceptable to many. Understanding how a ketogenic diet works to provide a benefit, also gives clues as to why it causes adverse reactions. And because the documented adverse reactions include serious illness and death, understanding why these might come about is a prerequisite for adopting this therapeutic strategy in a more widespread way. What insight we can glean from mechanistic studies will be the topic of several future articles.

Does the need for more science give ketogenic diets a green light or a red light? I certainly agree with the ketogenic diet community that more long-term and mechanistic studies are required. However, I disagree that, in the absence of the insight this research could provide, that everyone should just “try it for themselves”. We need to look at the information currently available for guidance. The studies do not ubiquitously show benefits; not everyone responds positively to a ketogenic diet; many unanswered questions regarding the effects (both positive and negative) of ketogenic diets remain; serious adverse reactions have occurred. As a community, we have a choice: proceed with great abandon, or have a more nuanced and accurate conversation of what we know versus what we don’t know. I support the latter and believe the capacity for harm needs to be just as much a part of the conversation as the therapeutic potential.

The Fine Print

Other diets do not trigger the same biochemical pathways that are activated by a ketogenic state. And while certainly other diets (Paleo, or the autoimmune protocol being good examples) stake therapeutic claims, the mechanisms of action are purely through micronutrient saturation and avoidance of foods known to be inflammatory. The ketogenic diet is different in that it was designed to emulate starvation, taking advantage of the biochemical benefits of starvation for certain body systems (mainly neurological, but this is also why weight loss is a common result of a ketogenic diet) while tolerating the detriments to other body systems (such as endocrine and immune systems). (These are even different mechanisms that a standard low-carb diet.) In this regard, the ketogenic diet more closely resembles a drug than a diet (in fact, many of the same pathways activated by a ketogenic diet are manipulated by anticonvulsant drugs), which should not be a deterrent in itself, but rather a caution to read the fine print and talk to your doctor before embarking on this course—especially if going “off-label” and using a ketogenic diet for purposes that have not yet been well studied. And this is why a thorough understanding of both the pros and cons of a ketogenic diet are necessary in order for every individual to make the best decision for themselves.

Citations and Additional Reading

This PDF contains a review of the literature on ketogenic diets.

Normally, my science-based posts contain a dozen or so references at the bottom. This post is special. With the help of the sagacious Denise Minger, author of Death by Food Pyramid, I have compiled an review of the literature, with a particular focus on the studies that report on and potentially explain the mechanisms behind adverse reactions (there are plenty of reviews available on the internet reporting the documented benefits). This review also includes links to original publications and summaries of over 80 scientific papers that I read in preparation for writing this blog post, the future posts that I’m working on in this series, as well as my Paleo F(x) 2015 talk. Download this free PDF here.

Collagen Veggie Blend

Up your nutrient game with a daily dose of Collagen Veggie Blend stirred into a glass of water or added to your morning smoothie!

Two small scoops gives you the equivalent of 2 full servings of veggies, 1/2 serving of high anti-oxidant fruit, and 10 grams of collagen peptides! And it’s 100% AIP!

JOOVV

Using a Joovv light has resulted in improved energy, markedly reduced fibromyalgia pain, boosted mood, improved skin, and weight loss. As you can probably imagine, I’m a crazy huge fan! Use code PALEOMOM at checkout and receive a free gift from Joovv.

Reader Interactions

Comments

I started GAPS about a year ago and then went Paleo. It helped with many of my symptoms including numbness and heartburn. I lost about 20 pounds. About 3 months ago I stopped getting my period. I want to start eating carbs again but I have leaky gut and suffered with candida. How would someone like me transition back to eating a diet with a moderate amount of carbs???? Please help. If anyone could explain to me how low-carb diets cause amenorrhea that would help as well…. I do work with a holistic practitioner, but I don’t depend on her for everything, and try to do my own research, so please don’t tell me to find a qualified practitioner…..she thinks it could be PCOS. But amenorrhea doesn’t necessarily mean PCOS, I’m just hoping it comes back. I have never wanted to get my period so badly.

Very, very, very slowly. Like increasing a teaspoon at a time slow. I think it’s great that you have a practitioner to work with and monitor you as you do this. Where I would start is a focus on non-starchy veggies first and lower glycemic load veggies and fruits (cooked if they cause digestive symptoms), and monitoring blood sugar levels carefuly (ketogenic diets can make you insulin resistant).

You could look at the Perfect Health Diet, it could be very safe for you and your gut. All of their evidence is very scientific. It ised healing carbs in safe (but still moderate) amounts (20%-30% carbs, 15% protein, 55%-65% healthy fats). Nothing is synthetic, it’s all real, nourishing food. They do advocate specific starchy veggies, so please take the time to read through their explanations and info for individuals who have health issues. I found it when I realized keto was not for me after my hair started falling out and I began to have an adverse physical reaction to eggs and am looking to transition myself. I hope this helps!

Natalie, google “Healthful Pursuit” and checkout Leanne Vogel. She practices nutritional ketosis and has cured her 7 year bout with amenorrhea (no period) using it. She practices a whole foods approach to ketosis, regular carb ups, and she has lots of free content that could help you get your period back.

I had to learn about the “carbing ups.” Being on Keto has actually produced more spotting for me when I remain carb free for too long. So every two weeks I sub in some good complex carbs, hummus, beans, and wild rice (yah I sneak some pita in there too) and so far so good!

I heard for the majority of women, Keto “fixes” PCOS. I would think if your period stopped completely, I would first rule our PCOS (blood test) and track you macros (are you really getting enough fat).

For the earlier comment with regards to Candida; I was a sufferer myself. Did the candida diet for 6- 9 months, then working in complex carbs/whole grains VERY slowly. But alas, carb free life is just for me as I feel more energized and have zero joint pain when there are no carbs in my life. Also started on a probiotic then too and never looked back.

I have been following Leanne Vogel’s fat adapted woe since June of 2016. I have been AIP since January of 2012. I re-introduced coffee, nuts, seeds, eggs and dairy on Leanne’s keto protocol. It is now February of 2017, I just got my Spectracell results back from my fx med doc. I have an extreme deficiency in all my B vitamins, probably due to the high phytic acid containing foods I have been eating. I have eliminated coffee, chocolate, and nuts and seeds. Lots of joint pain and tendonosis. My Omega 3s also tanked. I was eating fish, sardines and eggs and grass fed beef and fish oil supps and seaweed and still my levels are bottomed out. My clear thinking is reduced and my stress/cortisol levels have increased. I have also eliminated the dairy now. My cholesterol topped out at 340! I have switched from saturated fat to polyunsaturated some of the time. So I’m basically on a low-carb AIP protocol with egg reintroduction! I did lower my blood glucose levels to acceptable (avg 88) instead of high (between 102 -130 for the last 30 years). But I think I can accomplish this by lowering the amount of root veggies and fruit I eat on the AIP. And while this was not a primary concern for me, I did lose and maintain a 12 lb weight loss.

The mechanisms seem to be multifaceted, but yes, I think there’s compelling evidence that mechanisms include insulin resistance, low insulin, leptin resistance, direct endocrine effects, direct immune system effects, and effects on gut microbiome–each of which are at least in part due to inadequate fiber, nutrient-dense carbs, and phytochemicals. I certainly don’t mean to imply that dietary fat is bad, or that we should all binge on as many carbs as we want, but this is an extreme diet not replicated in nature (not even the Eskimos and Inuits, which will be the topic of a future post). It’s also a different situation than dipping into ketosis between meals or during intermittent fasting, which is clearly normal and generally not detrimental.

Youre wrong. You claim that there needs to be more research done, but its out there – yet there is a failure to read it. I am certain that the cause of deaths and adverse reactions is because of the electrolyte flush caused by keto diets combined with the sodium-corrupting anticonvulsant drugs (In fact i never saw you mention your understanding of HOW keto helps with seizures – only links to the research you claim to have read.) The salt/water balance is drastically affected by this diet. Thats why others would make the legitimate claim that keto was “done wrong”. A truly sustainable ketogenic diet includes heavy water intake as well as lots of salts. This is known to remove all uncomfortable and unhealthy symptoms of this extreme metabolic change.

If you look into it you will find that most anticonvulsants work by inhibiting the sodium channels.

So, if a patient was taking even a minor dosage of any of these medications, and then began to impliment rapid depletion of sodium via nutritional ketosis – there would be a unavoidable corruption of PH and all the systems to restore the balance have their hands tied behind their backs.

Also, this is the most common way for people to die by starvation. Not because of nutritional lack, and therefor end of energy production; but because of electrolyte depletion. Because the go into ketoACIDOSIS.

I totally agree Amanda K. I have been in Ketosis for months, with zero side effects. I have actually started getting normal periods for the first time in 25 years, being diagnosed with PCOS about 9 years ago (struggled getting pregnant for 3). I have also seen a HUGE reduction in inflammation in my joints. Joint pain free! Lost my excess weight over time. Much more healthier now than I used to be. My sister had other health benefits which included her reflux disappear, also normalised menstruation cycle and she has been on a Keto diet for 2 years(without having the need to lose weight). Our skins are glowing, no more breakouts. There are also documentaries about the sugar/carb industry (Coca-Cola, Kellogg’s to name a few) funding research teams from the Heart Foundation, Government Health Departments, Dietitians’ Institutes etc. Biased outcomes? I have become very skeptic about all the so-called scientific research on this and that. Go read up on the court case of Prof Tim Noakes in South Africa. Do yourself a favour and watch That Sugar Film by the Australian Damon Gameau, which documents the effects of eating supposedly healthy (low fat) foods and how the Carb industry covers up in the USA.

My sister sent this to me to try to put me off LCHF – I am a Banter – since Feb 2015 – and excited to see you reference Prof Tim Noakes here. I am one of the admin on an LCHF/Banting FB group with over 800k members and this way of eating is having phenomenal effects. So many women who have been struggling with PCOS and unable to conceive are having ‘Banting babies’ – we actually affectionately call them ‘Tim’s Babies’. And I have no idea just how many people have managed to reverse their Type 2 diabetes and bring their blood pressure down – must be 10’s of 1000’s. And this is not just because they lose weight. The improvements and conception often happen really quickly once they change their diet and start to eat exclusively clean, real, unprocessed foods. The difference here I think is that as well as dropping our net carbs to about 25g, we eat plenty of healthy fats – avocado, nuts, cheese, butter, streaky bacon, eggs, olives, chicken with the skin, oily fish. This helps to improve our cholesterol and hormone balance and promotes the health benefits you mention above 🙂

Exactly, anyone who does even the most minor research on Keto will first and foremost come across the precautions one should take if you have ANY health issues or are on ANY medications and to consult your doctor if so BEFORE attempting the diet. If you have any health issues or taking medications and you decide to not consult a doctor you have ignored the first and usually most foremost highlighted recommendation and cautions of the diet.

Hi Sarah I really do appreciate all your research! But as a nutritionist working with a therapeutic Keto Paleo diet for a lot of different applications, with great success (yes for only 2 years now) I have to ask you few questions: What kind of ketogenic diet was studied in the research you quote? I am aware of certain communities who do an indiscriminate keto diet for weight loss which includes foods like Crisco and Spam and does not even consider supplementation….A ketogenic diet per se, does not say anything about the quality of the foods you are eating, it just means you are using ketogenic ratios to achieve nutritional ketosis. I recently attended the Epilepsy Summit and was appalled at what kind of foods where served to sick children only in order to maintain them in ketosis….like shakes make with Canola oil!!!

I have absolutely no doubt that following that kind of ketogenic diet, any of the adverse reactions you list could easily ensue.

What I am disagreeing with you on, is that attitude that makes of every grass a bundle.

Any diet can be done either very well or very poorly, including Paleo! You should be very aware of that with all your experience! So I think that going out of your way to prove that a ketogenic diet is ‘bad”, basing yourself on research that never took in consideration what the diet actually consisted of, is a very limited point of view, and it could be misleading people to think that all ketogenic diets are bad!

What I think is a more accurate point of view is to inform and educate people on the quality of different styles of Ketogenic diets, and to suggest working with a professional, or at least to do a good amount of research before embarking on one on their own.

That is what I do for people through my blog, I educate them about the right foods, the right supplementation and the best way to stay healthy, still maintaining all the benefits of being in ketosis.

I hope you can reconsider some of your assumptions under this light and maybe give the right kind of ketogenic diet its earned value!

The lipoprotein immune system Sixty years ago researchers discovered that the lipoproteins participate in our immune system by binding and inactivating bacteria, viruses and their toxic products.(1) The lipoprotein immune system may be particularly important in early childhood, because in contrast to the antibody-producing system, which needs repeated stimulations to function properly, the lipoproteins work immediately and with great efficiency. There are many ways to demonstrate it. One example is that researchers have looked at mixtures of lipoproteins and bacterial toxins with an electron microscope. What they saw was that the toxin molecules stuck to each other and became attached to the LDL molecules,(12) and similar experiments with virus gave the same result.(13) In the laboratory it has been shown that human LDL is able to inactivate more than 90% of the most toxic bacterial products.(14) When Kenneth Feingold and his co-workers at the University of California in San Francisco reduced blood cholesterol in rats and gave them an injection of bacterial toxin, most of them died quickly but if they injected a purified human LDL beforehand, they survived.(15) Mihai Netea and his team from the University Hospital in Nijmegen found that this is not necessary if they used mice with familial hypercholesterolemia. Most of such mice survived, whereas normal mice died immediately, a beautiful proof that high cholesterol is advantageous.(16) When we are attacked by microbes, the white blood cells send a message to the liver by excreting their hormones, the cytokines. The liver responds by increasing the production of lipoprotein including the ‘bad’ LDL; yet another indication that LDL is a useful molecule. Most surprising is that apart from those who have been directly involved in the research in this field, very few know anything about this system, not even experts in infectious diseases or immunology, and hitherto I have not found a word about it in any current textbook.

Notes: 1. Ravnskov U, McCully KM. Ann Clin Lab Sci 2009;39:3-16. A short version in Swedish is available in Medicinsk Access 2009;2:

The lipoprotein immune system Sixty years ago researchers discovered that the lipoproteins participate in our immune system by binding and inactivating bacteria, viruses and their toxic products.(1) The lipoprotein immune system may be particularly important in early childhood, because in contrast to the antibody-producing system, which needs repeated stimulations to function properly, the lipoproteins work immediately and with great efficiency. There are many ways to demonstrate it. One example is that researchers have looked at mixtures of lipoproteins and bacterial toxins with an electron microscope. What they saw was that the toxin molecules stuck to each other and became attached to the LDL molecules,(12) and similar experiments with virus gave the same result.(13) In the laboratory it has been shown that human LDL is able to inactivate more than 90% of the most toxic bacterial products.(14) When Kenneth Feingold and his co-workers at the University of California in San Francisco reduced blood cholesterol in rats and gave them an injection of bacterial toxin, most of them died quickly but if they injected a purified human LDL beforehand, they survived.(15) Mihai Netea and his team from the University Hospital in Nijmegen found that this is not necessary if they used mice with familial hypercholesterolemia. Most of such mice survived, whereas normal mice died immediately, a beautiful proof that high cholesterol is advantageous.(16) When we are attacked by microbes, the white blood cells send a message to the liver by excreting their hormones, the cytokines. The liver responds by increasing the production of lipoprotein including the ‘bad’ LDL; yet another indication that LDL is a useful molecule. Most surprising is that apart from those who have been directly involved in the research in this field, very few know anything about this system, not even experts in infectious diseases or immunology, and hitherto I have not found a word about it in any current textbook.

Notes: 1. Ravnskov U, McCully KM. Ann Clin Lab Sci 2009;39:3-16. A short version in Swedish is available in Medicinsk Access 2009;2:

Well said Vivica. It is nice to hear alternative views but I agree that food quality is essential for Ketogenic diets or LCHF. There are varying degrees of ketosis from mild to fully ketogenic. I think we all agree that we should just eat real food to minimize blood glucose spikes and inflammation. Sometimes we’ll be in ketosis and other times not. The metabolically challenged (by eating too much bad carbs for too long) would probably do better in ketosis then someone brought up eating real food. Cheers.

I think the problem has more to do with micronutrients than the ratio of your macronutrients. You can eat a nutritially poor high carb diet or ketogenic diet, and in both cases it will lead to health problems. I think it’s somewhat missleading to focus on the macronutrient ratio, rather than micronutrients when making blogposts like this, because they trend to miss the main point. When you eat a ketogenic diet you cannot exclude all vegetables (and you don’t have to in order to be in ketosis) unless you want to miss out on important nutrients. Anyone registering the food they eat for a few weeks can see this. But it is also clear that you can get enough micronutrients and fibre by eating 30-50 gr carbohydrates per day. It’s not even hard, the Wahls protocol for example, has simple rules how to do this.

Just the red and green visual of pros and cons is ridiculously biased. Did anyone else notice that? The spacing of the wording and drawings to clearly make the red cons side look much longer. Does the keto diet threaten the future of your blog? It does not need to. Very deceptive…too bad.

One thing I have definitely noticed is how very unpleasant and short-tempered you all seem to be. It reminds me a bit of how I feel when my blood sugar is low – except that I make sure to not open my laptop and start yelling at strangers. Can you eat this way and still be kind to others?

What about all of the animals consumed in this diet? Have any of you looked into the ENORMOUS strain cattle place on the earth and its resources? Or does that just not matter, as long as your skin is all shiny or whatever? What about the ethics of consuming animals? Have you visited the slaughter houses? Would you be willing to kill animals so you truly know what you are consuming? Call bacon what it really is. Dead pigs. How can a dead thing do your body any good at all? Does none of this matter to you pro-keto people? Honestly? If you answer, please don’t waste time with the usual “vegans are pale and sickly and stupid” crap. Vegans are body builders and firemen and pastors and teachers. Just for the record. Too many of us only care about “ME! MEMEMEMEME!” This is not good for any of us.

So, you eat plants while they are alive in the dirt-root and all? And you are aware plants “feel” too and signal each other, right?

I think such a deep emotional guilt for eating animals should be some sort of mental disorder. Humans would have never survived without dead animal flesh-no indigenous people ever lived solely as vegans and certainly not optimally. Also, many humans have an intolerance and allergies to many types of plants-but I guess they should just get over it to spare the animals.

I guess if you’re worried about the planet that much-you don’t drive a car or use anything plastic? Do you wear only hemp clothing because it’s much more sustainable than cotton? What about your house? Are you tied to the electrical grid and the water systems?

Do you get mad at lions for eating antelope? What about chickens eating grasshoppers? You can forgive animals for eating others animals, why is that? They are so insensitive to not just go against their biological functions and eat plants.

If you take a look at science and the organs that are part of our digestive tract compared to herbivores (the cow with his many stomachs), you would see that we are designed not only to eat meat but to digest it fully in the stomach before entering the small intestine-giving you the optimum absorption of vitamins and minerals…compared to your vegetables that rot and ferment in the digestive tract.

But, at least you’re saving animals. After all-their health and lives have much more worth than measly ol’ humans. So far, through this thread I haven’t seen anyone be ugly to anyone else-simply people just stating their opinions. Maybe you are reading the words with too much emotion.

you must live on meat, olives and avocados. supplement with fish oil because your joints need it also eat some raw chinese herbs also consider eating raw saw palmetto leaves also consider eating raw almond flour burn fat, it is more efficient and gives you more energy

Hilarious, fruits are not toxic, can you consume too many yes, but u can consume too much water also. Fruit has a high sugar content which is great for storing energy over long distances. That’s how humans have used it.

It is a bit bonkers how sure people are, with nothing to back it up whatsoever. Fruit is in no way toxic, unless you only eat fruit, and then kiss your pancreas good bye. (In preparing to play “Fruitarian” Steve Jobs, actor Ashton Kutcher adopted the same diet. Luckily he “only” ended up with a bad case of pancreatitis. It killed Steve Jobs)

THANK YOU FOR POSTING THIS! when I first started being eating Paleo and eventually moved to a keto diet, I assumed I must have been doing it wrong because I felt TERRIBLE. I realized after a few weeks of misery that maybe keto just wasn’t for my body and that just like anything else, it’s not a one-size-fits-all prescription. Often times, the praises of keto wonders are hard to ignore while the adverse reactions are rarely mentioned.

The terrible feeling you had, if you had done even minimal research on the diet, was because of the transitional period. It can last 1-2 weeks and there are plenty ways to minimize these adverse effects known as the keto flu, which include making SURE you drink plenty of water AND absolutely get enough electrolytes (sodium, pottasium and magnesium being the most important) Failure to do so is not good for you and will feel awful and is often the reason keto gets a bad rap in addition to people who attempt the diet who have health issues and take medications and do not consult a doctor prior to, which can be dangerous.

I think in addition to a temporary Keto flu, one can be depleted in electrolytes on this diet at other times as well. Maybe women a little more susceptible to this. A simple homemade drink with a bit of Lite Salt (potassium/sodium combination), a little magnesium powder, some sparkling water, and lots of ice, could resolve the problem. I drink this about once per day, and if I forget, I can wind up not feeling very well.

One-size doesn’t fit all! I love that you are acknowledging this. And, if you have to supplement your way through your diet to feel okay — that’s a yellow flag (in my opinion) or at least a more stressful way to live (always evaluating certain factors and supplementing to feel good).

I truly appreciate the balance of this article, and that it is bringing up various sides of the pros & cons of the Keto diet. Thank you for your courage in talking about things that some people are reacting to versus considering and seeking to understand.

There is always a lot to learn. The nutritional industry can be so confusing, biased, and full of fear on both sides. With any extreme change, precaution is wise and having a good practitioner guide you along the way.

I am happy someone is talking about this topic. Hopefully we can find the truth . I agree it seems reasonable to discount the connection between epileptic children and a more general population, and equating so called “nutritional ketosis” with starvation appears historically as a rhetorical device of conventional interests. There appears to be some misunderstanding in the origins of the ketogenic diet, modern medicine may claim its discovery in a therapeutic sense, however the diet was used as far as I can tell by explorers and natives for centuries for the sole objective of avoiding starvation!

It is evidenced in the film Shackleton’s frozen hell, where a whole crew of men survived in extreme weather eating only a preparation of boiled meats.

I got really sick after trying a keto diet. Lost hair, developed psoriasis which I never had before, became paranoid, anxiety attacks, lethargy, and other things. It was horrible. Never again. I’m not built for keto!

I developed racing heartbeat, in the ER twice, the docs think it is a tachycardia, but my heart rate went back down by the time I got to the ER. I was so scared, even after adding carbs back for a couple of months, I unfortunately just had another episode, and my anxiety around it is so bad. How long did it take you to get back to “normal” after stopping your ketogenic diet.

Maybe your potassium was low. I read somewhere that because alot of water weight is flushed out on a keto diet that potassium gets flushed out in the crossfire and needs to be supplemented back in. I just use “No-Salt” on at least one meal a day.

Thank you Sarah, I appreciate the work you do. I did a course of the HCG diet late last year, during what turns out to have been a Hashimotos flare (20/20 hindsight). I was gaining weight alarmingly, fatigued, enormous pain in hips to knee area. This hugely restrictive diet, and hormone treatment is starvation though the fat levels eaten are very low. During the 4 weeks I was on it, I guess I was in ketosis. My pain subsided, I lost weight (6 kilos), and although I wasn’t active I slept well, and had no digestive issues. I felt like I was taking a pause, a deep breath. I plateaued weight wise on the diet and investigated further and discovered I had Hashis. I would never do that diet again, loosing another 6 kilos, and most of the pain on the AIP and medication for my thyroid, but I wonder if being ketogenic has to be an all or nothing affair. Could some people cycle it, say 2 or 3 short periods a year to mitigate symptoms, but guard against adverse effects? Thanks again:)

Heather, I believe there are methods of cycling ketogenic diets. I have heard of body builders cycling ketogenic diets with carbs. Google “cycle ketogenic diet”. However, I’m not sure if there will be information about cycling being used for symptom mitigation or alleviation. That would be interesting to see.

I believe the risks you enumerate are present with most diets and I think you article lacks of that specific balance and probably the studies that you refer too. Its like all these possible side effects are only associated with keto. Eat crappy food keto or not and yes you can die sooner or later. I totally agree with Vivica comments and there is more to it than fat and low carbs for keto and same thing for Paleo and other diets. I eat a wide variety of food dense in nutrients Paleo style while avoiding carbs. My blood panel improved significantly within less than a year. Is this mean that everybody going keto will react the same? maybe, maybe not… all depends of your complete lifestyle and food choices. Im sure you can cook commercial bacon in hydrogenated fats and drink the juice and be in ketosis big time. Would I ever do that? not as long I have a brain. I think it is all about food quality and variety. The real question is: “ Is it tougher to stay within the keto ratio while eating high quality nutrient dense food that cover all our needs“. The answer is probably yes. And this the main reason I would not recommend keto to everyone and this is probably why it is even probably a risky business for some and in that sense I agree with the above risks. If you are like me… like testing, researching, trying new food, aim for quality over quantity, make adjustments based on evidence… keto might be for you. Insulin resistance in keto as been shown to be temporary and when you think about it is kind of a normal mechanism to maintain a minimum blood glucose level. At the end, we are all on the same side, aiming for healthy lifestyle and promote it. Continue your great job with this website 🙂

Hi Eric, i have been keto-ing for 3-4 weeks now. I have been quite a health nut over these years. I try and eat lots of veggies (non starchy ones) in my keto diet and my daily test strips say i am in ketosis, altho have started eating some meats again and also bone broths. I try and get organic and free range meat and bones whenever i can but for someone who has been veggie and recently pescaterian for many years, the reintroduction to meat is the hardest part to keto for me. I find it hard eating enough without the meat/fish otherwise.? I like what you have written here and i wonder what your daily diet intake looks like? I have not had one migraine in the 3-4 weeks of going keto which was my reason to try it as before this i was in an awful migraine pattern of 3 a week. I was desperate to change my health. This has undoubtably worked for me although i have been feeling very low energy in the last week and also needing to drink a lot of water. wonder if you have any tips to share? Many thanks Chris

I am currently in keytosis for the first time. Call me shallow, but my buddie and i are simply doing it to try to get a six pac in 30 days. I am a hige believer in eating healthy grains, and am slowly adding them back into my diet while still staying in keytosis. I can definitely see that staying in this diet for long periods of time could be detrimental. But to loose unwanted pounds and then add carbs in through veggies and ezekiel bread seems like a great method to me. I am not an expert. But i have done a lot of research on the subject, and your artical is one of 2 articals that i have ever found that are against it. Most of the sites and articles are very for it. And the reviews i have read from people who have done it are all awesome. What do you think about using it for a short period of time? I am still getting spinach, leafy greens, and 1 slice of ezekiel bread every day and staying in ketosis.

OMG! Life long Paleo Auto Immune Diet is associated with 100% mortality!

That statement is true, science based, and statistically sound.

We are all going to die some time, Paleo diet, ketogenic diet, vegetarian diet……whatever diet. We all face 100% mortality.

I think of it this way:

The ketogenic diet is a “therapeutic” diet.

Nutritional ketosis via carbohydrate restriction is a natural phenomena, and can accompany a therapeutic diet or a maintenance diet.

There are a variety of ketogenic diets for epilepsy, cancer, diabetes, weight loss, dementia……

The composition of the ketogenic regimen therefore is of obvious importance.

Unfortunately for many, the diet was designed to produce ketone bodies and not nutrition!

Among the pediatric population there are a variety of diseases, including congenital and inborn errors of metabolism, some of which are not compatible with normal survival.

For some of them, the ketogenic diet is not the appropriate solution for their metabolic disease. This is not the fault of the dietary regimen, rather the person prescribing it.

There are some assumptions there made about the “risk” of certain changes in lipid composition. And, extrapolations from rodents ……………

I agree with Vivica who said it perfectly:

“What I think is a more accurate point of view is to inform and educate people on the quality of different styles of Ketogenic diets, and to suggest working with a professional, or at least to do a good amount of research before embarking on one on their own.”

Sarah has produced brilliant and clear nutritional guidance for the Paleo autoimmune diet. It sounds like there will be more to come about the macronutrient composition of the ketogenic diet. Let’s see what follows.

What research? What studies, exactly? Give us a paper to go to.Seems to be a lot of general criticism. A lot of the “adverse reactions” seem like mere life events, and maybe correlation at best.

As you age and eat carbs ( if you aren’t very lucky gentically) then you can count on being delivered to diabetes door. But if keto doesn’t work for you, it doesn’t work for you. Everyone has to discover their own nutrition and their own way. But cutting carbs is proven to be effective to lower blood sugar. It does mine.

Read all the studies of the 80-plus articles and summaries used in preparation for this article by clicking the bright red link to “DOWNLOAD PDF HERE” or click the link in the last sentence at the end of the article.

It seems that reading the actual studies, rather than the review, is necessary here. I started reading this article with great interest until I read through some of the peer reviewed articles referenced in the blog post. The first question that comes to mind is for how long and when did subjects experience adverse effects (e.g., short-term during a transitional period or long-term)? What was the nutritional composition and macronutrient balance of the experimental diet? The answers to these questions are not consistently detailed or clear in the study methodologies if addressed at all. Another concern is whether this post and the literature review reflects an understanding of research design and statistical analysis. For example, the discussion of death being an adverse effect gave me pause. As it should! “Effect” implies causation whereas the Suo et al, 2013 paper reports, “During the follow-up, 10 children died, among which 3 had withdrawn from the KD for more than 6 months before death, 2 died of status epilepticus, 2 died of pneumonia, 1 fell from height, and for the remaining 2 cases, parents were unwilling to disclose the cause of death.” No data or analyses are provided that suggest causation. In others words, the authors do not attribute the diet as the cause of these childrens’ deaths! So it appears to me that Suo’s findings have been unfairly misrepresented. Which begs the question: was this misrepresentation an oversight or unintentional error or should we distrust the integrity and accuracy of the entire literature review offered here? I was hoping for an objective discussion of the pros and cons of a ketogenic diet and sincerely appreciate the amount of work that went into the post. And it’s so well-written, my technical concerns aside. However, this ultimately felt quite biased towards a particular point of view based on a questionable review of the literature.

This diet occurs in nature. How do bears survive when they enter hibernation? They are starving, but sustained on their own stored body fat and the nutrients within. This is very well documented. All mammals have this capability.

The fact that you left out insulin resistence, leptin resistence, and metabolic disorders leaves quite the crater in your article. You spouted much data on epilepsy which has far less impact than the obesity epidemics that follow the style of eating like the standard american diet. Epilepsy is a serious condition, but far less prevelent than obesity.

Is this article your answer to the recently popular documentary Fed Up? Which in and of itself did not specifically promote a ketogenic diet, but it did cite a WHO report about a carbohydrate limitation which is ketogenic? Being critical of your view I would be interested to see how a very low carbohydrate diet could cause nutrient deficiencies.

I have the upmost respect for the Paleolithic viewpoint. Eating whole foods, real foods, no GMO, no toxins, no hormones, etc. A ketogenic diet has a lot in common with Paleo, and both can be undertaken simultaneously. They are NOT the same of course. Maybe that is your angle, you want to keep Paleo distant and above this ketogenic trend.

Do as you wish. Your so-called balanced discussion is like right-wing FOX NEWS fair and balanced coverage: propaganda. But I guess you got website hits, that is what counts, right?

I went keto in Feb 2012. I was Paleo for months before that (so I was already quite fat-adapted) and then I went the Paleo-ketogenic route (so that includes bone broth, offal, the whole shebang). Within 2 months, my thyroid started acting out, and my hair started falling out. I will never do keto again. I’m now at 75-120 grams of NET carbs per day, and I feel great. That’s where I need to be to function properly.

And yes, when I was ketogenic, I felt like I was hibernating. LITERALLY. My eyes were closing off in the middle of the day, and I was so cold, and I wanted to sleep. I was that bear you are speaking of. The problem is: humans are not bears, and they should not be bears, unless there’s a good reason for going ketogenic (e.g. shrinking a tumor).

And you want to know the other thing too? I have ALL of my days in keto written down on Cronometer. I’ve never hit my nutritional goals on keto, even if I was eating oysters/offal (very potent foods). With my current Paleo+ diet (I do the Kris Kresser version with a little soaked beans, but no rice), at around 100 gr of net carbs, I feel healthy, as I should. It’s still low carb, it’s just not keto. And it works for me best.

Eugenia, do you mind sharing your records of eating keto. I personally am interested to see and I think it would help give others something to compare to. If it’s not easy to share hear in the comments, please e-mail me [email protected] It would be greatly appreciated

What do you mean your eyes were closing off? I am having eye issues, been in ketosis 9 weeks. I am not super strict with it and do not count every single thing so I am somewhere under 50 g carbs. I feel good otherwise, lost weight and no cravings for foods like before.

So what would you recommend for someone who’s post-menopausal and can’t tolerate the carbs–insulin? It’s easier and cheaper just to cut the carbs–not all of us are 20-30-somethings, and still have our estrogen. Let’s hear from The Paleo Grandma sometime!

Yep. All these 20, 30+ girls are in for a big surprise in a few years. This thread probably isn’t really the place for this topic. But almost nothing written anywhere by anyone in the LC/Paleo/keto diet world applies to 50+ women. Everything changes. No one has any real-life help to offer. Maybe when the gurus are 50 and I am 70 there will be some good stuff 😉

Absolutely agree ladies! I love when 20 something guys try and preach to 45 year old woman what works for them. Ridiculous. I notice it seems to be woman in the perimenopause years who have trouble with vlc/keto. When estrogen is too high and progesterone already too low. Considering how little medicine seems to know about menopause to begin with … I’m not holding my breath any of this will be figured out in my lifetime. It’s definitely a warning older woman should heed though.

Wenchypoo, Trina, Brenda — we need to form a club or new forum. I couldn’t agree with you more. This is a major hole in Paleo/ancestral health topics. Maybe it’s because there are fewer of us mature women following this lifestyle. You have to step out of the Paleo arena to find more mature men and women like us addressing our issues. I appreciate so many of the brilliant Paleo minds and all they have to offer, but it does get tiresome sometimes hearing the 20 and 30 something perspective on life and health most of the time. IMO not enough real life mileage to fully appreciate the intricacies and complexities of aging.

That said, I feel that Dr Sarah is very balanced in her approach and in this article. IMO the big point is that there is a LOT of ketogenic emphasis right now in the Paleo community and so young people are perhaps at greatest risk as a group of thinking that they should be following this type of diet. It is important for us to understand the difference between short term therapeutic protocols and sustainable lifestyles including diet.

I say Kudos to Dr. Sarah for standing up to the movement and presenting a more complete picture of the pros and cons. I do not consider this article to be a slam against ketogenic diets at all. She is arguing that they are not a panacea, not that they are evil.

ya’ll need to check out Stephanie Person, she is 48 and did a ton of research on keto. You can find her on youtube. She talks a lot about metabolic derangement and how it causes massive troubles in preventing you from adapting to keto.

This is what happened to me when I went keto (which made me ill). I have metabolic syndrome. Problem is, I’m doing what she suggests (e.g. iodine, selenium, DHA etc, circardian rhythms) and the syndrome is still there. Which means no keto for me.

This is so scary, did any of you speak with your doctors or a doctor before eating this way? I keep seeing just regular people ask others “How do I do this?”. Do you really want a stranger to tell you how to eat?

I went into menopause early, lived with so much illness my entire life, now I am a healthy, happy vegan. But I have a feeling I am wasting my time here 🙁

I was a Keto missionary a few years ago. I was convinced that it was the right diet for everyone. I lost a lot of weight, but I have now gained it all back again (mostly because I have been eating crap). Two years ago, whilde still on a ketogenic diet, I started fainting, and get severe shivers (and it was really hot). I bought a blood sugar mesuring device. I descovered that my bloodsugar was as low as 1,3 mmol/L (I think you use a different measurement in the US). But my blood sugar acted strange. I remember checking my blood sugar, and it was at 3,5. So I would eat a banana. When I checked after half an hour it was 1,9. I would then eat some meat and veggies, and it would stabilize around 3-3,5 which is still low.

My doctor said that my blood tests came back with perfect blood sugar levels, so there was nothing to worry about, because it wasn’t diabetes. But still I think fainting of low blood sugar levels is serious. I still do sometimes get low levels. Especially if I eat to much fruit og sugar. But it doesn’t look like I get this effect from starchy veggies in the same way. My blood sugar never seems to go above 6 or maybe 7 if I had a lot of sugar. But my doctor said that it is not high enough to be diabetes.

Anyways my blood sugar regulation seem to be very bad, and I have suspected that I actually do have diabetes. I have two questions. The first is; how do eating a fruit result in low blood sugar in only half an hour? Is this Hypoglycemia? The second questopn is; what can I do to better regulate blood sugars? Is there any nutriens I should focus on, or fibers, type of carbs or any other foods that might help?

Thank you for talking about this. A lot of my experiences makes more sence (I listen to you and Stacy, and already knew a bit of her struggles).

Nobody here can diagnose you, but your symptoms are consistent with reactive hypoglycemia. Your blood sugar spikes because you are most likely insulin resistant already. It takes a lot of insulin to finally get the cells to respond to glucose levels in your blood, and when they do, all that insulin drops your blood sugar low–it can make you feel awful.

The best way to avoid these symptoms is to reduce carbohydrates so that less insulin has to be secreted. Eating protein and fat and restricting carbohydrates to non-starchy vegetables will keep your blood sugar on an even keel and get rid of the hypoglycemia symptoms. It’s your choice if you want to bring your diet within ketogenic levels or not, you may not need to in order to keep your blood sugar in a normal range.

Fruit is clearly causing you issues. You might try SMALL servings of lower glycemic fruits (berries are the best choice), and never eat them alone–always have some protein and/or fat with them–e.g. berries and cream (use full fat coconut milk if you don’t tolerate dairy).

Reactive hypoglycemia is definitely an early symptom of insulin resistance–and unchecked it is very likely progress to Type II diabetes, although it may take decades to get there.

Thank you for taking the time to respond to my post. Just to clearify, I was on a keto diet when this started hapening. I just tried bananas to get my blood sugar back to a normal level, I would never eat a banana back then, as I was on a less than 20g carbs a day diet. When I was in ketosis my blood sugar was constantly low for the last few months, and I felt bad all the time (the first two years I felt good). My blood sugar levels have become a bit better after I started to eat more carbs, but sometimes I still have these symptoms. I can now eat bananas without my blood sugar going crazy (and sweet potatoes and other starchy vegs).

My question was on what micronutrions could help, rather than a macronutrient question. One Of Sarahs points in the Paleo approach is that micronutrients are much more important than the macros, and that is what I find interesting. I think my macros are under control. But if I eat high glycemic foods I have problems, but medium GI is perfectly fine now.

And when it comes to diabetes, I am just wondering, if I had gotten tested before I did my diet change, maybe I would have been diagnosed with diabetes. I just stated “low carbing, high fatting,” without checking anyting with my doctor first.

I am now pretty well checked by a doctor. But they don’t want to check for “metabolic syndrom” and things like that in my country. And they are not concerned about low blood sugars. I haven’t tried to eat a “standard diet” again, to see if I would have high blood sugar if I did (but I don’t feel like going there just to get a diagnosis I don’t really need).

Not sure if you saw the Keto for Cancer panel from AHS14. Dr. Champ and D’Agostino discussed woman becoming hormonally “messed up” and hypoglycemic following keto diets. Contrary to what the evangelicals say, they actual doctors implementing the diet know it doesn’t work for everyone.

The first study she linked to is a case study of a single child. The child died of acute pancreatitis, and the paper simply assumes the ketogenic diet was to blame. How do we know that? It appears as just guesswork.

The studies which show deaths with the ketogenic diet were done specifically on epileptic children and not healthy children or adults. They studies have no control, and do not take into consideration existing health complications. One of the papers actually states: “In other reports, deaths during the diet were reported, but the researchers stated that the deaths were not thought to be due to the KD, but rather, the deaths were indicative of the severity of the patients’ basic condition and of the increased morbidity and mortality of this group, whether or not they are on the KD”

So those studies show nothing. There’s no reason to be specifically concerned about deadly complications of the ketogenic diet in healthy adults. Long term research on the ketogenic diet is non-existent. More research would be nice for sure.

I went ketogenic for a while and felt great at first then started to feel REALLY bad and my weight loss stalled. I started adding back in carbs in the form of fruits, sweet potatoes, occassional rice, ditched the low carb sweeteners for maple syrup and honey and the weight started falling off and now I feel like I could sprint three miles! My conclusion: the ketogenic diet is good/and or therapeutic only for the short term. I think from my research that some people,like myself, need the carbs for their thyroid or liver to turn T4 into T3?(or is it T3 into T4? if forget) anyway, I feel much better.

My conclusion as well, from experience. Keto is important for either specific problems (e.g. tumors, bipolar etc), but only for the short term. Two-three months later, regular low carb for life is healthier (e.g. 100 gr net carbs avg). According to Jack Kruse’s version of seafood-based keto, he suggests that we should go keto for 2-3 months in the winter, and then come out of it for the rest of the year.

Ketogenic sure made me lose weight… far TOO much. I was eating 2,500+ calories a day and losing weight, constantly hungry, and nauseated. I developed gastritis. I also developed a slew of neurological problems (orthostatic hypotension, near syncope, vagus nerve activation, tachycardia). I was trying to starve gut fungus while on antifungals. I think it was far too much stress on my adrenals. I felt like my digestion came to a halt, as did my blood. I’d wake up and feel stagnant. I will never go back to low carb / high fat again. I have gained 12 pounds (still lean) and have much more energy bringing back starchy tubers, rice, and some fruit, and cutting back on protein and fat. I have fat malabsorption even with less daily intake.

Ashley this is very interesting. I too was on the ketogenic diet for a month or so and was just diagnosed with gastritis. I was wondering if the ketogenic diet was a precursor to this. So how have you been feeling? Are you back to normal? I have been suffering with stomach pain and slow digestion for a couple months now.

Just FYI – there is one more side effect missing from your list: dry eyes & mucous deficiency. In my case this was so severe I ended up at the opthamologist half thinking I was going blind. Eye drops helped but when I upped my carbs, it went back to normal.

I had a number of the other adverse reactions including such severe disruption of my menstrual cycle I was worried I had triggered pre-mature menopause. That took 6-8 months to return to normal after resuming a higher carb intake.

Good post. The ketogenic diet has the potential though to have positive effects on digestive symptoms, for example it has been shown to be beneficial for treating reflux symptoms in obese individuals as well as being helpful in treating IBS symptoms with diarrhea-predominant IBS

As a responsible nutritionist that highly respects bio individuality, I’ve said before that it’s possible that keto isn’t for everyone. BUT, I think the key is following a WELL-FORMATED keto diet, making sure to include enough nutrient dense foods along with the healthy fats, and I think this is the key point that many people are missing.

If you don’t get enough EFAs critical for brain health and many other physiological functions then that could be a problem. If you don’t eat fermented foods or enough prebiotic fiber to nourish your gut bacteria then that could be a problem. If you don’t have a proper source of iodine, selenium, and the many other nutrients that play a role in thyroid health then that could be a problem.

Keto isn’t about stuffing yourself full of bacon, butter, and coconut oil all day (although all of these are healthy fats). Nor is it about eating all of these “keto cheesecakes” and “keto pizzas” and other keto-ized foods. It’s about shifting your metabolism to a predominantly fat-burning state by eating copious amounts of VARIOUS FATS and *moderate* amounts of protein, while also consuming enough nutrient-dense WHOLE FOODS. Personally, I think Terry Wahls has one of the most well-designed ketogenic diets I’ve ever come across (Read “The Wahls Protocol”).

Furthermore, I have personally met experts like Christine Cronau and Ann Childers that have been following this diet for 10+ years with a lot of success. These are the people we also need to be consulting with on how to properly design this type of protocol.

I read your article and started doubting my diet. I started 1 year ago – because I am over 40 and what ever I ate – I gained weight. And I started with ketogeniC/ LCHF diet. after one year (and achieving my goal) I am eating daily few strawberries, or berries… I enjoy eating oranges or other fruits, just I do not do it in the evening, not to increase my blood sugar for the night. I read many many articles about ketogenic diet, about the metabolism boost and I do agree with you as for the hair loss. But it took just about 1 month and then the hair loss stopped. And now my hair is longer, shinier and went from thin to thicker. And my menstrual cycle is more comfortable than before – I am not in pain (not even do I have back pain or chest pain, like I used to have before) – the whole situation feels very “flown” – I don’t know how to describe it, but no pain, no difficult days… I am happy.

My face is glowing, many people told me that I look much better than 10 years ago (in may 30-ties). And I am happy. I am full of energy, though I live in a warm and humid place, and eating gluten and processed foods made me feel always tired and then hungry again. My mom read (probably similar resources like yours) and made me think / read / research about the kidney troubles while on ketogenic diet. But you know what? I have never felt better, I eat eggs, proteins, soups, whipping cream, sour cream, bacon, sweet potato (which I hated before), green salads, tomatoes, broccoli, cauliflower, … butter and coconut oil. And love to bake – while using coconut / almond flour, erythritol (adding even raw honey from time to time)…. I have even added green beans, but also beans and chickpeas in generall (especially during winter as soups)… and legumes … whether “forbidden” or not, I enjoy them 1-2 in a month.

so I totally agree with Vivica – we need to know what we eat. … and agree with few more people stating here – to EAT REAL FOOD…

and I truly believe that Paleo is very similar to Ketogenic diet, or Ketogenic diet is similar to Paleo…. though I never went to doctor and never consulted anyone about the differences, just reading the posts on internet and blogs…

Virtually all of the “documented cons” are a result of nutritional ketosis in the absence of fat adaptation. Newer studies (predominantly on athletes) which have been long enough to either allow the sample set to become fat adapted or which compared already fat adapted vs. Non fat adapted subjects do not find these cons to have merit. As with any science we are limited by the methodology. The methodological flaws of most studies are in duration. It is now relatively common knowledge that the interim conversion of a glucose burning to an efficient ketone burning metabolism not only takes time, but is also no fun. In other words: The cons are temporary the benefits are not.

I have been on the so called “Ketogenic diet)” for over two years now. I chose it because I had an advanced case of papillary thyroid cancer. What I saw was the starvation of remnant cancer cells, as cancer cells thrive on sugar and carbs, and are starved on a high “good” fat diet. I am doing well. I can see where any diet would not be a panacea for everyone, absolutely not. My diet is a “good” high fat diet, nothing with fats such as hydrogenated, or the like. I eat mostly an organic diet, tons of greens, grass fed or organic meats, and very little fruit. I do love bacon which I special order from Whole Foods because it is specially prepared without any sugar.Years ago, I heard and followed to live on a very low fat diet because fat would give you a heart attack or something else. I only eat fats such as organic coconut oil, oil, butter, but it has to be a good, high grade, not any junk. I don’t count calories, or carbs, or how much protein or fats I eat each day. I don’t measure anything, just eat a balanced whole food diet. I enjoyed each and every post above, even though I agreed with some more than others, but on a personal level. Each person should consider to get off of any diet that makes s/he sick, of course. I enjoyed, as well, that these posting are so current. My very best to each person who contributed so much to these postings.

I tried the keto diet for a long period last year. There were benefits but also costs. I feel like it burnt me out, stress wise, and since eating a lot more carbs recently I feel they have allowed me to recover somewhat from all that stress. One thing that did improve on keto were my vitamin d levels…without supplements! My doctor was amazed. I do wonder if that was down to having a fat based metabolism since vit d is a fat soluble vitamin.

I really enjoy your posts and agree that most people need to carefully consider the type of diet they try due to individual biology. I do agree with Vivica, Sara Keough and Jana though. I did the Atkins diet for 1 year back in the mid 90s and had wonderful results. The main thing I noticed though was how many people doing the diet did not make wise food choices and would think they had a license to consume bacon all day everyday or some other issue where they were not varying their diet to get enough of all the nutrients they needed. The food quality choices were questionable that I saw some others make and goes to previous posters comments about the need for some to consult with a nutritionist. I fell off the wagon after a year and made bad food choices incorporating grains, legumes and sugar and the weight came back. Years after that I did the Rosedale diet with its more moderate protein carbohydrate ratio and also did really well with that. I had my doctor review the diet before I started it and he thought it was really well balanced. I am now a middle aged woman and the drop in progesterone has revealed numerous food allergies that the progesterone had shielded me from. I now utilize the AIP along with Wahls recommendations on the amounts and types of vegetables/fruits to incorporate in my diet. I think it takes careful consideration of the stage you are in and the diet requirements you personally need.

There is a vast difference between the research done with epileptic children and the LCHF diet followed by people today that can increase ketone levels. To even transpose the one directly on the other shows a lack of knowledge and creates the impression that a disciple of one ‘type’ of diet is attacking a newer, threatening one. Even if the author repeatedly tries to deny it.

The same applies for the repeated attempts to call a strict LCHF diet a ‘starvation’ diet. While the medical literature typically defines starvation as the lack of glucose or carbohydrates, this article tries to create the impression of a continues lack of food.

While being in starvation will produce ketone bodies and was a quick way to induce the state in those epileptic kids, one of the main benefits of a modern LCHF diet is EXACTLY that there is no hunger.

All in all, a classic article that attacks purely from a dogmatic view. Bad form.

I’m so grateful for all your hard work and objective commitment to the science of our ever-changing diets. I think it is extremely important as offshoots of Paleo continue to evolve into a template we adjust as time passes to suit our individual bodies’ nutritional needs. I’m someone who likes to understand the ‘whys’ of what could be happening within as I listen to my body and trust my gut instincts about what is currently working for me. Don’t ever stop, Shero Sarah. You are doing a wonderful and meaningful work. I feel overwhelmingly grateful that I started researching Paleo and incorporating AI just as you began sharing the results of your personal research and journey. Just keep acting with integrity and courage, head held high. I hope Paleo keeps moving more towards open frank discussions with all points of view being offered, discussed and aired opening with excitement. Thank you!!

With our enthusiasm to improve health we often forget about any caution and keto diet is a good example. We just want to believe in some cure. And there are almost no doctors willing to help us with dieting approach (at least outside of USA). So we are just all alone with our different health conditions which are not well understood and not cured with medicines. In our lonelyness all we have are blogs and sites. But people tend to speak louder about their success, not about their fail. So actually we have not well balanced picture. The articles like yours are like a cold water : they help to clear mind. Thank you for your great job!

PS Special thanks about PDF file with reviw: I am surprised about Inuits as they are rоutinely mentioned as an example of natural keto diet! Looks like it is not so about them.

Sarah, Thank you for this balanced article. When it comes to fasting and keto, I always wondered… How are gender differences relevant? This does not seem to be really addressed or considered in the research, but you are one of the few Paleo experts that have addressed the issue of gender and nutrition. Which is remarkable, because we know more and more about the links between nutrition and hormones/endocrin system, yet nutrition is typically addressed without account taken of the major differences in hormonal composition between the sexes (or impact of age). When one thinks about fasting, I find very remarkable that in traditional cultures practicing fasting (of which there is great evidence) it is usually men, and not women, who do fasting. Or women do it in a lighter form. Also, traditional cultures typically had special diets (and no fasting) for fertile women who may potentially concieve, pregnant women or breastfeeding women (which women being practically always in one of the three categories). So I find rather interesting that the keto diet has so many dcumented potential adverse effects on women’s reproductive system. But also on conditions that tipically affect women more than men, like ostosperosis, bruising, etc… I’d love it if you could give a closer look to this.

Wait till you watch your child sit and drool having 100 seizures a hour and not even swallOw her own salvia. You would try the diet in a heart beat! Read the side effects of the drugs they put your 3 year old on then get back to me. This diet saves lives. try getting a3 year old to eat what you consider to be the healthy way. You do what it takes to save them today! !!! What’s the point if they are dead tomorrow?

I see that there is more to come and maybe my two cents here will be addressed. First I do not think there is any one diet suitable for everyone. We all know there are vegans living long, healthy, vibrant lives. And there are stories of people eating only meat living healthy lives. Every study has some limitations and I doubt there are many of us that are going to click on all of those links to see what they might be in order to prove or disprove a keto diet’s effectiveness or safety for ourselves. I don’t really understand why it is necessary for a Paleo blogger to take this on as a mission after all of the flack that Paleo gets as well. I think it creates more divisiveness. On to my main point: Paleo did not work for me at all and I hold the Paleo blogging community partially responsible for at least the “visual” message that gets portrayed about what Paleo is. One caveat: it is the same with the LCHF community. When we scroll through our feeds 95% of what we see offered in the way of recipes is sweets and SAD alternatives, either laden with too much fructose or fake sweeteners. Not only do I have metabolic and neurological issues but I have a very difficult to beat sugar addiction. Paleo for two years left me heavier than I have ever been because I could not get rid of the cravings and even though I was very active, and so thought I could handle the sweet potatoes and honey sweetened treats, they were horrible for me. At one point I got so frustrated that I decided to attempt the Wahls protocol. Oh my gosh it was a disaster. I stuck with it for about two weeks thinking at some point all of these fruits and veggies will kick in and heal me! Nope…I could barely leave the house (bathroom) and I felt awful! Just about as bad as I was as a vegan. Now, I have been doing keto and the cravings are gone. GONE! This is huge for me. I feel better than I have in a very long time. My stomach just digests the food and I don’t even notice it. Complete calm in there! I will be carefully watching for any symptoms of something going wrong but for now I actually feel like I am healing. Paleo didn’t do it for me. It got rid of a lot of the bad symptoms but IBS flare-ups continued and were worse at times, blood sugars were creeping up, hashimoto’s was not under control, and I had a very hard time controlling the cravings. I feel Paleo is a godsend for many people but I think that everyone needs to assess their own body and figure out what is going on for themselves. I still believe in Paleo but also see the benefits of a ketogenic approach so am sad to see this divisiveness when there is a lot of crossover in the recommendations and benefits of each.

Perhaps the controversy lies within the context of when and how someone is in a ketogenic or nonketogenic state. Is it possible we are having mixed results as not only an effect from our current biochemistry (which may be imbalanced) but because we are trying a keto diet in the wrong season? Most sources of carbohydrates do not grow year round in most places. So, maybe the answer is that we are to eat seasonally, how nature would intend for us too: i.e. more carbs in the summer, less in the winter. Just a thought. Has worked for me.

This week I had my one year anniversary of when I began the ketogenic diet for health reasons…

In that time, the ketogenic diet has stabilized my reactive hypoglycemia and resolved my insomnia (caused by blood sugar dysregulation), giving my adrenals a much needed break. Nutritonal therapy and keto have also helped to heal my gut and liver, regenerate my pancreas and gallbladder, regulate my endocrine system and hormones, and replenish my neurotransmitters.

If that isn’t the road to recovery, then I don’t know what is. I am determined to be well.

I’m grateful for this article and yet even more perplexed. My naturopath just asked me to begin a ketogenic diet for the next two months due some really out of whack blood work results. I’ve been flowing a rather rigid Paleo diet since October 2014. I began with the AIP diet from October to January and did great then slowly transitioned into a regular Paleo diet. I’m so confused when a good dr tells me one thing and my intuition screams another. I’m just not certain the ketogenic diet is for me. Is there any way that the AIP diet would be superior for autoimmune and thyroid issues?

I have read many PaleoMom articles over the years, but after reading this I now will treat everything she writes with more skepticism. This is not a PhD science article but one with cherry picked research to make her point – i.e. bias. I bet it served the purpose of driving more readers to her site. Very Very disappointing Sarah! I would expect better.

I appreciate your article on pros and cons, but also want to say that no 2 Ketogenic diets are alike. I am a member of a Ketogenic group on FB, and within that group, we all work hard and make sure we are eating healthy. Example: Fiber? I eat lots of fiber more than most, at least 25 -35 grams a day. Vegetables? Yes I eat them. Salads, berries. It really depends. Many people eating keto will eat bacon cheese burgers, ham sausage, brie, lots of bacon, etc. Not saying thats unhealthy, but there is no “keto police: out there, making sure people also eat vegetables. Get fiber. Ensure a healthy immune system, use something like probiotics, etc. We are out there though. I know many with sterling bloodwork, people running marathons on keto. I appreciate that you note that more research is needed. But in terms of deaths: to “first” write about deaths in your article, and then to say: oh, its mostly epileptic children….makes me wonder. Why would people put kids on this type of diet? And if they did, who was there to monitor the diet to make sure they got adquate nutrition? Anyone? Were vegetables and supplements included? It is sad to hear anyone dying, but there is no direct proof that it was the keto diet and not the effects of medications or combinatin of both. If we are to be scientists, we would have to look at keto diets without the additional factor of medications. And how many people have died due to being obese? I think for those who have more than 100 pounds of weight to lose: sometimes up to 300 pounds or more to lose, that this is one effective way, but has to be done in a healthy way.

From the European Journal of Pediatric Neurology, “Physiological side-effects of the ketogenic diet in children with refractory epilepsy”: “All detected side-effects were well-manageable and never a reason for KD discontinuation…” I guess Paleo Mom knows better!

No point in a ketogenic diet if you are well. But ive been suffering greatly for 20 years with kimuras disease which has no know cause or cure. The disease kills kidneys, the immune suppressors used to slow it down kill your kidneys… They say the ketogenic diet isnt good for the kidneys.. Well three weeks ago i had no options left and started the diet. Currently my tumour and symptoms of the disease are gone. In 80 years no one every managed that before. Why it worked have no idea but this diet is faaaaaaaar more potent than any drug ive been on. I have no plans to eat carbs anytime soon.

It worked because a diet in refined carbs (and hydrogenated oils instead of saturated fats) is junk food and drug insustry propaganda. Sadly, ignorance, such as this article abounds everywhere. A few qualified experts do exist (Dr Jeff Volek, Dr Peter Attia, Dr Eric Westman [except for the soy and canola]). 99% of doctors have NO nutritional training and their malpractice insurance restricts them to following death by food pyramid (and subsequent medications). Fat phobia and government subsidized grains (including the ones fed to factory animals) are slowly killing us all. Not to mention hack articles pretending to be scientific…

Very disappointed in the article. It is more of the same garbage pretending to be unbiased etc etc etc. you can name nearly any endeavor and come up with a list of frightening possible consequences. I’m sure the list associated with exercise would be longer and result in more deaths. People will go to great lengths to protect the profitable status quo and find all kinds of excuses to dismiss. It is fear ok getting not and unbiased look. I am so tired of two presumptions: 1) glucose for fuel is the normal state ( ketosis the abnormal) and 2) ketosis is like starvation thus… (fill in your petty pet peeve nonsense here.) when you intellectually jump of the glucose-is-normal cliff, or, the its-like-starvation cliff you can go in only one direction: Downwardly wrong. As your are in a plummet of stupidity all conclusions are suspect. Ketosis us not like starvation, which is not eating. Ketosis is eating. Stop being automatically stupid by calling it starvation. It is a different dynamic. As for glucose, try for once to think if ketosis as the prime and preferred metabolic state and burning glucose the minor, secondary metabolic state. Don’t you get it? You star with wrong limiting definitions that lead you to inescapable but wrong conclusions. Look at ketosis as the superior metabolic state, the evolutionarily preferred one. The judge it by those merits.

You are right, I think that this is an anti-communism, pro-capitalism article. Capitalist doctors will do any thing to defend the capitalist medical system, and the capitalist philosophy of dieting. Capitalist doctors believe in high carbohydrate way of eating. Because they benefit from high-carbohydrate diets, capitalists ruling classes want people to get sick, to get diabetes. As opposed to communist medical systems that are totally in favor of people, not in favor of profits

I think that this article is a little bit biased, I have about 3 years following the ketogenic diet without 1 single day of high-carbohydrates cheat meals, without 1 single day of a high-carb day. I have about 3 years doing the keto diet non-stop, and I am not dead

I’m pleased to see so many comments that basically debunk this article. Perhaps a ketogenic diet doesn’t work well for everyone but it has worked amazing well for me and for everyone I know who is doing it. Weight loss for me has been acceptable but not extraordinary, but overall mood, energy level, cognitive functions including memory, bio-markers, etc. all have shown marked improvements.

I would be disappointed if people read this article and decided on that basis to not try a ketogenic diet. I will likely remain on it for life and I agree with the prior comments that note that there are very many formulations of ketogenic diets. For instance, doing a ketogenic diet with only 2% or less of total calories from protein would still put one in ketosis if the extra calories didn’t come from carb but that would clearly not be a healthful option. That, however, is not evidence that there is something wrong with the ketogenic diet.

I dont want to be rude. But many people eat terrible food. Full of refined carbs and other rubbish. Then they cut out carbs eat real meat and get results lol. Keto def seems to be good for some and for treating ailments. I think there is enuff evidence. But does it really beat my gameplan? Well balanced diet with super veg, strength training and some cardio? I feel great i have cheat meals I enjoy my food. Why wud I give that up? I love my metabolic rate…I love my body saying foooooood mmmm. I love eating 5 to 6 times a day. Why wud I remove an entire food group? I use carb cycling between .5 and 1.5 grams of carbs per day depending if Im trying to lean out or build muscle. It just seems that keto is an excuse for many who try to sit on thr bums but they still wana lose weight. Then they claim to be full of energy? What does that mean? Energy to get thru the day? Thats not energy hehe. Running a new pb over 100m or crushing ur next game.

Actually I do keto, and I don’t sit on my bum all day. You have a serious misconception here. I hike uphill several miles on the weekend, lift heavy weights during the week, and do cardio. I do everything anyone else does to lose weight, but I eat ketogenic.

I have been keeping track of what I would not be able to eat or drink that is proven by science to be beneficial for ones health. 1.beet, carrot, apple and ginger juice. Fresh made organic. 1 of these would prob put me out of keto. I have decided not to try a keto for my next lean out phase. I just dnt see the merit right now and its just too restricted. The premise of cutting out things just because they will keep u out of keto just doesnt seem sensible at this point.

I have to say, you’re doing a great job of espousing last century science here about Keto. I would suggest you do a bit more research and look at some of the more recent studies in this area. What I just read is something I would expect from a dietitian trained in the 1990’s.

Thank you for this, I couldn’t agree more. I’m a T1 diabetic and eat less than 30g per day, although ketosis isn’t my goal, I am almost always in keto. My bloodsugars are better than most non-diabetics, my A1c is 4.8 and I take about 30-35u of insulin per day. After being diabetic since age 6, close to 30 years, it’s not a matter of if but when complications will set in due to elevate bloodsugar. Diabetics can’t process carbs, were carb intolerant. So it’s necessary to cut them out to maintain control. Some don’t realize this or choose not to, and that’s okay, but this “scientific post” is damaging to those who are considering cutting out carbs in order to gain control over their health to avoid blindness, kidney failure, heart disease, loss of limbs… Definitely disappointing. I hope the science wasn’t cherry picked and it was a true oversight.

Lol, so instead of listening to a qualified dietician, we should listen to some random guy on the internet who talks about studies but doesn’t provide them? The cult like attitude of keto dieters is all I need to see how bullshit it is. Anything that attracts such snowflakes is suspect.

Did it occur to you that we are listening to a qualified dietician? You’re making assumptions about something you clearly don’t understand. I work with my doctor, and my dietician who showed me what to eat, and educated me on the ketogenic diet.

I’m a Type 2 Diabetic who has been on the ketogenic diet for 2 months. My blood sugars have been amazing, but I’ve always wondered why you don’t often see anything about long-term negative side effects of this diet. Clearly high blood sugars also have long term side effects, but it’s hard for me to weight high blood sugar (which I see immediatly when I increase my carbohydrate load) and the effects you mention in this article. This has given me a lot to think about, thanks so much for all the hard work you’ve put into the research and writing. It’s great to read information from people in this community who actually have the scientific training to back up their writing.

There are risks for any life style or diet and yes there are reasons to consider temporary cycles of mild ketosis and non ketotic states. However I do want to point out that several of the potential “side effects”/problems that are mentioned are directly linked to sodium/potassium balance and a lack of minerals/vitamins and arguably fiber. If someone does a “well-structured” ketogenic diet, gets plenty of green leafy veggies, minerals and a good sodium/potassium balance many of those issues will be avoided.

There could easily be a case/article pointing out living on a glycolitic metabolism 24/7, 365 for many years has much higher risks.. For major diseas known to society today. I agree am argument can be made for cycling one metabolic states.. And perhaps following a seasonal approach.. But I feel this article is looking for a reaction is isn’t entirely accurate about the true risks.

I have been in ketosis for 30 years due to pre-diabetes. I am 56, I am at my perfect weight (120 pounds) and I have NO medical problems. My cholesterol is low and my doctor says I have the blood pressure of a 16 year old. All those things on your list, I know people who have been cured by them eating a ketogenic diet. And as far as “death” goes, there is no diet that can prevent that. Alzheimer’s is caused by the hippocampus being starved for cholesterol. Then it dies and triggers the domino effect of Alzheimer’s. I learned that from Alzheimer’s Solved by Dr. Henry Lorin. I cried when I was told by my doctor that I could not have any more carbs. I said I would rather be blind and deaf. It changed my life so much that I could kiss his feet. Ketosis is the Fountain of Youth. You need to try it for a month before you put it down. One week to get into ketosis, one week to get the hang of it, and the two weeks of increased mental and physical energy, while you don’t have any more hunger and cravings, you eat until you are full, and the fat comes off and your muscles grow even without exercise. And your health problems evaporate. I know it sounds “too good to be true”, but it works for everyone on the keto forums. It will work for you too.

Your “Dr. Lorin” is a fraud. The cause of Alzheimer’s is still unknown. The cause is believed to be a combination of intrinsic (eg. genetics) and environmental factors. Pretty sure “Dr. Lorin” would’ve won a Nobel prize otherwise.

Nutritional ketosis has changed my life. I don’t care what you say or what “data” you have, my experience with it has been wonderful and I was Paleo before nutritional ketosis. For me there is no comparison.

I was very disappointed reading this article. Either your sources are false or you haven’t researched a Ketogenic diet. Ketones actually reduce inflammation – they do NOT cause inflammation. I have been using a Ketogenic diet for 7 years. I have lush thick hair, I’ve rid my body of mycotoxins and yeast and I have been symptom free from multiple sclerosis for many years now (and take no meds). Many studies are on the rise using this diet to treat autoimmune diseases (like Terry Wahl’s). And I do not feel deprived eating delicious food full of fat and butter. Occasionally I miss fruit during apple picking season but being able to walk and run again far outweighs a piece a of fruit.

The sources aren’t false, but some of the interpretations are incorrectly overstated. Case studies, in particular, are prone to sampling error. The truth is many people don’t turn to keto until they are already VERY sick for one reason or another. People in those cohorts are always going to have adverse effect reports, and correlation does not imply causation (particularly on a backdrop surrounded by many uncontrollable confounds such as is present in these disease states).

Thanks for sharing this. I am 40, & recently diagnosed with MS. I can barely walk & definitely can’t run or dance. No medication seems to help me. The Paleo diet has minimally helped but it seems the next step is to try ketogenic diet.

It is hard to remain critical after finding a diet plan that seems to work. For Sarah this is the autoimmune Paleo diet, and for Denise it may be an embrace of the role of animal foods in her diet. However, both Sarah and Denise should consider challenging the beliefs that they hold most dear. Sarah and Denise have given the health community many insightful articles and reviews. It is possible that this topic, the sustainability of a ketogenic diet, has not been as rigorously examined as other topics that Sarah and Denise have covered. The negative results the sick children in these studies experienced were likely due to factors other than the ketogenic diet.

Okay quick scan of the list says keto causes Pneumonia? Seriously? A germ causes it. Bacteria/viral/and even possible Fungi. Now, if you can not even get THAT bit correct..I am completely not accepting the rest of your statement as factual. Anecdotally– – ALL my (36 years of) IBS problems stopped COMPLETELY. Seriously the difference is astounding. I never thought that I would go through life without the crippling symptoms that I had experienced for so long. – T2 Diabetic. Off all meds and A1C dropped from a 10.8% to a 5.0% ..and I expect even lower next visit. Reduced blood pressure…inflammation..blood sugar..improved lipids..liver enzymes..every single lab result has improved Dramatically. My physician practically does cartwheels in excitement over my results. (BOTH my GYN and my previous Cancer surgeon(highly renowned in her field University Hospital systems) recommended Keto as prophylactic protection against many issues that they treat.).

I think that I would like to read the references(and dates) on this chart’s “bad” list.

Think for a moment, about the sheer impact, of the idea getting out, that fasting -or even eating less all-around, would have on the food industry.. Anyone freed from the addiction of carbs/sugar, knows the grip of it and is reluctant to go back to it thoughtlessly; trimming the calories happens effortlessly, fasting is no longer a feat. This is a huge detriment to the food industry and and even bigger problem for Big Pharma.. Married to the government, corporate fascism is where america’s nutritional guidelines are derived, From the ‘feed” type foods; grains as the basis of our diet pyramid to “Breakfast is the mo$t important meal of the day”! and the disease that springs from it, is coddled till death with a pill for every condition ….five studies you say? That’s not a drop in the bucket for these moguls to buy. Today it’s safe to say, that any subject of science to be peer reviewed, -and is going to involve A LOT of money; is already bought and sold.. …it’s up to each one of us to be more speculative and discerning than ever

Yes im begining to realise this to be true . Since the agriculural revolution 10000 years ago the massive explosion of human life is based around this lie of mass carbohydrates consumption. life as we know it would exsist if some caveman didnt figure out he can plant a seed insted of butchering a wild animal. since that very moment the whole dynamics of life shifted into the false world outside of natures governing ecosystem . Thats when the lie began And mankind is not sustainable without this lie

Yes im begining to realise this to be true . Since the agriculural revolution 10000 years ago the massive explosion of human life is based around this lie of mass carbohydrates consumption. life as we know it would exsist if some caveman didnt figure out he can plant a seed insted of butchering a wild animal. since that very moment for the first time in the history of the earth the whole dynamics of life was taken away from natures governing ecosystem and humans started playing god. Thats when the lie began And mankind as it is today is all structured around this fundamental lie. Its the reason we are here

hi, Dr. Sarah… there is a path way for each and everything that happens inside the body right? So.. will you please explain the pathways for each and every adverse effect of ketosis that you have mentioned above. thank you

You can do some research as well. I specifically researched regarding bi polar and discovered losing sodium on the diet mimics what anti convulsants do (which are typically given to bi polar patients) so the info is out there.

That’s ridiculous, “Human” – low sodium is not a symptom of a ketogenic diet. It’s a symptom of not eating right. I used to have low sodium levels on a high carb diet. Now that I’ve learned a bit more about my body’s requirements, my sodium levels are fine – ON a ketogenic diet.

AIP helped me with many symptoms, but it wasn’t until I did AIP AND keto at the same time did my inflammation completely go away, my brain fog cleared, my blood sugar regulation issues disappeared, morning nausea and sudden hunger disappear and I finally felt good again. I was eating too many carbs to feel well on AIP, about 100 grams a day, due to having butternut squash and sweet potatoes throwing off my blood sugar.

I continued to have severe brain fog and digestive issues on AIP that I don’t have on AIP plus keto, and I do not test as allergic or intolerant to any of the AIP foods I was eating.

I’m currently transitioning into Wahls Paleo Plus, a ketogenic diet along the same lines as AIP, and I’m doing great. I’m getting 10-15% of my intake in carbs a day from AIP-approved vegetables in the proportions Wahls recommends, yet still losing weight and having my auto-immune symptoms decrease while I stay in ketosis. It’s working for me, and I’m so happy I moved away from AIP and towards keto and Wahls because my health has only improved from it.

AGREE! I was Paleo then AIP for Hashimoto’s (had it for 20 years). I then went AIP Keto and amazingly things are starting to even out. I also was eating too many of allowed carbs and having the same issues – carb cravings, brain fog, depression, anxiety, no weight loss and the endless cycle of junk.

I basically eat vegetables, protein and fats (more fats) – (and track my food) with a treat of berries every now and then. Perfectly happy. Oh, and I work out intensely 10x per week (because I want to and can!), have a trainer and have been doing this for 5 months with no lack of energy, no crashes and plenty of power. Sleeping perfectly, loving my food and feeling so much better.

The replies just prove again: The key is not to invent the perfect diet but to just find the right diet that fits to your personal biology! The same diet can be healing for one person and inflammatory for another. It´s the same with every singe diet / macronutrient composition! I now have read SO many contradictory experiences from the same diets that I´m now a firm believer in the different metabolic type theorie. It´s all about finding where you are at the spectrum! Plus some details concerning food intolerances and allergies. And don´t forget environmental factors, for me it was mold… I wish everyone well on his journey! Just stay open to the signals of your body, it´s needs can slightly change from time to time.

This is completely irresponsible. I have been on a 35 carb Paleo (no grain period) KETO way of eating for years. I no longer have chronic bronchitis, my moods are quite balanced. After years of yo you dieting I have maintained my best weight EVER with no effort. This is a wonderful way to live not ever DIET again. Please do not take this fear mongering article as gospel.

It’s a shame that you don’t put your physics degrees to better use, Sarah. You really do have a lot of great information but I feel you could use your physics background to much better use.

If you looked into this issue from a physicists perspective you would understand that food = electrons & protons.

To be called The Paleo Mom and to say ketosis could be bad is just contradictory. Paleo people did not eat carbs in the winter. They would have been in ketosis most of that season. Then carbs were slowly ramped up during Spring and Summer as increasing photons from the sun permitted.

Ketogenic diets can be dangerous if not administered correctly, but not everyone adheres to the same plan. Finding the right balance is key. A good ketogenic diet includes both eggs and avocados, and avoiding the temptation to go for an overkill of nutritionally empty fat calories. Try to consume under 1500 calories per day, but at least 1000 calories per day. Make sure your body is adequately hydrated, but not over-hydrated either (the best clue on this is the color of your urine, rather than an actual water intake guideline). Do not consume more than 60% of your calories from fat. Seek nutrient dense foods as your carbohydrate choices which should account for ~15% of your calories and choose high quality animal protein for about ~15% of your calories. The remaining calories should be complete proteins from plant sources and light snacking, as needed to make the diet easier for you. Contrary to popular belief, it is OK to have some fruit—but make it healthy by being high in fiber and low in sugar like raspberries.

Overall, if you have found the right balance, your body will tell you the rest. You won’t even want to look at bread—you’ll throw it out. You’ll find that you are NATURALLY consuming an appropriate amount of sugar without any struggle. You will avoid foods that are not filling or being absorbed appropriately by your body. The only real downside for the diet is if you are an athlete, as it is hard to make the diet work for such a person. But I firmly believe that losing those extra pounds first is the priority. Once you are down to a healthy weight THEN you can find another diet that is suitable for an athlete. Exercise will do NOTHING but make you more hungry if your diet is terrible. So you have to prioritize which to fix first.

I really cannot thank you all nearly enough. As a 52 year old battling breast cancer, I have been on a ketogenic diet for 5 days now. Prior to my double mastectomy, I was on it as well – AND THE INFLAMMATION WENT DOWN. Is Dr. Sarah seriously a physicist? Sheesh! OK, anxiety levels have backed down after having been sent this link by a family friend. I’m so happy to hear of everyone’s results – I KNOW this is the way to go; it’s the one thing I can control. Thanks again for those of you looking at this article with a critical eye…..

Hopefully the linked studies contain more meaningful detailed information about the composition of the ketogenic diets studied. This article does not summarize that aspect at all. (Maybe future articles do, but I would like to see something pointing to that information, an indicator of its importance.) Like all observations re the impacts of diet, results depend on the context and specific composition of the diet. For example, what were the animals fed – were they factory farmed or grass-fed? That affects the composition of the animal fats consumed, which would affect the outcomes listed. Also, a ketogenic diet that focuses on animal foods and fat and keeps vegetable intake low is not the same as a Wahl’s style protocol, where a high (low-glycemic) vegetable intake counteracts some of the negative impacts of the high fat intake. These are important questions to explore and studies that don’t consider these questions ultimately aren’t translatable into evidence for making decisions.

I was in ketosis for 8mths. I ate everything green… straight from my garden, Lots of eggs from my free range chickens, lots of coconut oil, animal fats, olive oils, meat, fish, nuts, dairy, occasional fat bombs like bacon grease coffee (yum). Always checking ketones, below 20 carbs/day (if that). Always in mild ketosis….lost all my love handles, looked ripped. Was exercising 5-6 days a week. Competing in endurance races….but…I think it was killing me. Inflammatory markers went through the roof. CRP 3, Lp-pla2=230, ldl-p almost 1800, total cholesterol went over 300, homocysteine=15. I have bruises on my butt and back that have never gone away. My teeth turned brown like an anorexic. I’m sure there’s a reason for all this but how the hell can one know what exact freaking food to eat to keep from dying on this type of diet. At the rate things were going for me, I was a heart attack waiting to happen. 5 mths after exiting ketosis my inflammatory markers dropped to near perfect levels with the exception of homocy.

“but how the hell can one know what exact freaking food to eat to keep from dying on this type of diet.”

Perhaps, just perhaps from the tons of *real* resources out there, like PubMed or the various real health sites. And I am very curious if you had those values checked before the diet? What you’re describing is the diet causing what it is used to *cure*.

NEquals1, if I were to guess based on your markers, you might’ve lacked adequate intake of green vegetables, or had a problem absorbing vitamin B, particularly folate. Also, I would question the source of animal fats you were consuming, as grass-fed vs. grain-fed animals have a drastically different fatty acid profile, grain-fed fat being highly pro-inflammatory. Instead of the bacon fat bombs, I would’ve opted for organic ghee or other healthier fat with very low PUFA to stay in ketosis. At a quick glance, you sure seemed to have followed the recommended keto protocols, but before getting discouraged, I’d question the source of the proteins and inflammatory fats you may have overloaded in your diet to end up lacking in other vital nutrients and minerals. I personally don’t think a strict keto diet is healthy in the long run (but useful for therapeutic resets) and opt for a modified keto/Paleo while limiting (but not eliminating) inflammatory excess carb to upkeep thyroid and liver functions. Unless a person has a severe metabolic or clinical disease, conditioning the body to effectively metabolize various sources of fuels seems to be much more sensical in the long run.

With my mother being a nutritionist I grew up in a world that emphasised natural whole foods. I recently tried a keto approach for 3 months. I was losing fat and after a n initial adjustment was feeling fine. After 3 months I had an extensive blood panel done. The results were staggering, My a1c spiked, glucose was up, triglycerides were up and most importantly there was a huge increase in my small, dense LDL particles. I was crushed as I had high hopes for the approach. My father was diabetic so the low carb approach appealed to me but it was clear that a ketogenic approach was not right for me. I find some of the comments slamming the author and others proclaiming that a keto approach to be the be all and end all for everybody to be incredibly ignorant. The fact of the matter is that no one approach is right for 100% of the population.

I followed a ketogenic diet quite strictly for about 9 months and it has practically destroyed me. The adverse effects were at first very occasional, then transient and intermittent until the point where everything suddenly got much worse and I crashed. I am now very depressed both due to all my symptoms and my own stupidity at following this diet without adequate research. The ketogenic diet seems to work for some people, for others it can be a catastrophe.

This woman clearly hasnt tried the ketogenic diet herself! Maybe she should do that before vilifying it. And she is clearly ignoring the newest science on the subject. I think she is biased. I have been in ketosis for 2 years (i measure my ketone levels regularly with Glucomen) and all my lifelong health issues disapeared during the first weeks! Of course, im sure you can do a keto diet the wrong way (eating industrial oils or not enough minerals, being still afraid of fat or animal foods, not eating enough fat, or too much protein) but i have been careful to do it the right way and its been the best decision of my life! My family is also on it now and my Dad (he was prediabetic) has now an excellent HbA1c and avoided becoming diabetic. We all lost weight so easily, when it was impossible and unsustainable before. I advise everyone to try it. You wont regret it.

Check out to podcast below for detailed information on why this post is misinformation and irresponsible.

Most of the studies cited here are from children with epilepsy, on a variety of other drugs, and on a Johns Hopkins keto shake diet that was later determined to be deficient in many nutrients required for a healthy diet, particularly for developing children.

Thank you for this- after 2 years keto my hair was falling out and my energy levels were in the toilet, and my tummy hated all that fat. After tweaking for a long time, I decided striving for ketosis was not for me. I keep my carbs low, raised my protein and while I don’t focus on eating majority of fat, I’m not afraid of it. My hair is growing back in and my energy is great now.

Those arguing this article- I’m glad it works great for you but guess what? Your way doesn’t have to be everyone else’s way. Some folks may have adverse effects on any way of eating. Some people make keto feel like a cult LOL it’s ridiculous.

Many people who do great on keto could’ve done just as well on a very low carb diet without needing to be in ketosis. Radical thought I know.

Thank you, Kitty. This has been my experience too. I have until recently been a member of a Keto Diet facebook page and became so discouraged when I heard that people were losing 4, 6, even 10 pounds a week, while I lost only 4 pounds over 2 months, despite strict adherence to this way of eating. When I sought assistance via the support group, I was simply told that I needed to further restrict carbs (I was already at 20 g net carbs) and to further restrict calories (I was at 1350). There was no acknowledgement that some people just may not lose weight on this plan, and much feedback that I must be doing something wrong. Finally ditched keto and am on a moderately restricted carb diet that is much more reasonable. Am finally enjoying eating fruits and occasional starchy vegetables again. Heaven! Am meeting with a nutritionist this week to map out a new strategy for weight loss, and it definitely won’t be keto. I agree, I’m happy for those people for whom it works, but it’s not the magic bullet for everyone.

I tried a low carb diet for a few months and had adverse reactions. I developed tachycardia and my semen volume decreased to almost nil. I had to give up because we will be trying to get a baby next year. I hope my condition reverses after a few months. I have since increased my carb intake and the heart rate is going back to the sub-100 bpm range, but semen volume still low. This is my personal experience so as others have mentioned the diet is obviously not safe for everybody. But unfortunately you can’t tell unless you’ve tried it on your own.

Its sometimes difficult to tell who’s symptoms are BS above and who’s are not. Its hard to believe that someone would continue a diet for many months to years with brown teeth, GI issues, and depression. And a big LOL to Mr. Semen-100bpm. Have you considered dehydration? Also, my crap detector tends to come out strong when a Paleo-centric nutritionist (my research is based on the awards below) predominantly bashes another diet, or lifestyle (but I haven’t read her follow up blogs that may shed some additional justification or maybe more positive light). There are plenty of hypocrisies in a Paleo diet from fattened farm animal meat, something that didn’t exist way back then, to potatoes, a food that fits the profile but is conveniently disallowed.

Thank you all for the entertainment!

I personally believe that Keto is likely great for some and crappy for other body types/biological makups, but I also believe that no single diet depleting or nearly depleting Fat or Carbs should be sustainable as a lifestyle unless there is a specific biological dependency/reasoning for that specific diet. There is a balance in life. Many natural vitamins/antioxidants are found and best absorbed when eating certain carbs or sugary fruits, just as other vitamins and minerals can best be absorbed when eating fats and meat protein. To completely eliminate a group may allow one to control weight, which in turn can naturally assist with many diseases, but may bring other ailments into play. The human body is pretty remarkable. When one of the big 3 (protein, fat, carbs) is eliminated from a diet, it can have a drastic effect in an individual. Keto does severely limit carb intake, but in fairness, that number can be increased slightly by eating foods high in fiber, and there can should be “cheat days” built in.

I’ve tried quite a few diets in short stints such as Whole 30, Paleo, low fat foods for weight cutting, and a few others. What I found is that common sense works best for me. Stay away from whites (refined sugar, flour, rice), exercise, and drink less, drink more water, don’t worry as much about fat intake (the right fats)… I am currently trying Keto just to see what happens. A couple of trainers at a gym are on it and they swear by it, as do a couple of local nutritionists, plus who doesn’t want to drink coffee blended with butter and coconut oil (actually pretty tasty) then not have to worry about eating til dinner? If it works well, I add it to my (I’ll call it a) modified Whole 30 as a go-to when I need to lose some weight or feel energized. I’m a severe foodie so I’d never completely give up components that could make up an amazing 3 to 15 course meal.

One last thought: Concerning an active lifestyle, a Keto diet may be right for a crossfitter’s quick aerobic bursts and power, but the lack of carbs in those diets may not be suitable for a marathoner or triathlete. Again, not all diets or lifestyles are suitable for everyone. That is the last of my way too long response…

I came across this post after listening to Keto Talk episode 23 by Jimmy Moore and Adam S. Nally, D.O. I am in agreement with their assessment of this *research*. I am an avid cyclist and used to burn through tons of carbs to support my riding. Unfortunately through the course of time my lipid panel suffered. I’ve been keto for about 2 months and my lipid panel is awesome now. I thought riding was over but after a few weeks of being low carb I took to riding again but at a slower pace initially while focusing on burning fat. I have been able to build back up to longer rides and I am getting closer to my normal pace. The biggest improvement to my riding is not feeling the bonk after a strenuous ride. I have completed a serious ride, then worked in the yard a couple hours, and never felt pressed to eat all because I am now burning fat. The adaptation takes awhile to be fully fat burning and back at race pace. Your generalization is unfair that this lifestyle is not appropriate for marathoners and triathletes. The only good diet (lifestyle) is the one that you can stick too and yield positive health benefits and I think we can agree on that. I been Paleo/primal before but found it a little difficult. Adjusting my macros to be keto has done the trick for me and my overall health. I plan on sticking with keto as a lifestyle choice and the naysayers can keep on being naysayers.

Hey Peatwo, I respect your opinion and can’t really do anything about what you think. Of course I considered dehydration. In fact I religiously replenished my electrolytes during the time I was trying out LCHF, but my high BPM remained constant, and had constant fertility issues. I’ve even had my electrolytes checked every few weeks at my local urgent care center confirming I’m right at the ballpark of normal. If it worked out for you then I’m happy for you. I’m just saying in the end not all people are alike and some would respond favorably or unfavorably to ANY diet. In my case it may have to do with my being hypothyroid, and so I was a less than ideal candidate for LCHF. Tough luck for me right? Just sharing my own experience.

Peatwo: Actually it has been shown that Keto is better for marathoners. It’s the shorter ‘burst of energy’ sports that tend not to get the benefits. Keto is fast becoming popular with long distance athletes and their performances are improving. It is also becoming accepted as a training plan for entire sports teams; rugby, cricket, etc. The Australian cricket team has a Dr trained in low carb/keto practice and the whole team is converting. Prof. Tim Noakes is a distance runner, who teaches and practices low carb/keto, Dr Peter Attia is/was a long distance swimmer and cyclist who practices this method of eating too. And there are many more.

I have had type 1 diabetes for over 40 years. Weeks after starting the Keto diet I started having vision problems. I read it was an indicator the diet was working. After 2 months I no longer used the Keto diet because my vision got progressively worse. A recent visit to an eye specialist due to constant blurred vision in my right eye has revealed a detached retina and a large hemorrhage. I have always had 20/20 vision, I got a pair of reading glass this year but rarely used them. After being on this diet for a few weeks I noticed the change in my eyes. When I noticed the spots and blurred vision I should have stopped it but because I thought this was proof the diet was working I stayed with it. At this point vanity and a desire to drop 10lbs has cost me sight in my eye. Good luck

It is possible that the drastic change in the diet had some impact, even more so if your sugar levels changed drastically. Further, the water and salt issues associated with switching onto a ketogenic diet are nothing to sneeze at or ignore. So, yes, it is possible that during those first weeks, the switch was hard on your body (I think it is a little on everyone’s), and played a part in the retina detaching. And, all that said, it could also be a sad coincidence. Diabetes, especially 40 years of it, itself is a major risk factor for retinal detachment, especially if some parts of that time it was less well controlled. BEing that you were willing to try keto, it’s likely your diabetes wasn’t perfectly controlled (pretty much impossible except on VLC diets or extreme regimentation). So, it’s possible that the timing just so happened, or that the underlying risk was high (it would have detached at xome point) and that something about making the metabolic switch triggered it to happen at that time. I wish you the best in your healthcare and treatments going forward! btw, you can go VLC and still get a lot of benefit for diabetes without dealing with some of the metabolic changes.

I recently attempted ketogenic diet after being on AIP for 16 months, and on day 5 ended up in the ICU in metabolic acidosis. I found this article in my attempts to figure out what the heck happened to me. I had thoroughly researched ketogenic diets and was convinced it would help me. After sifting through all the anecdotes of people who feel they must defend keto because it worked for them, it’s important to keep in mind that there actually are contraindications to ketogenesis. Altered liver or kidney function, carnitine deficiency, and mitichondrial disorders are among others contraindications.

Yes historically it makes sense that hunter/gatherers probably cycled in and out of ketosis based on what they could find to eat. The reality is that anyone who could not adapt to ketosis would have died without an ICU to administer bicarb to correct their acidosis.

It’s clear that ketogenic diets have benefits for some people and risks for others. It doesn’t matter how great it was for anyone else if it was literally life threatening for me.

Thank you, Paleo Mom for this this resource so I can learn that I not the only person who developed renal tubular acidosis from ketosis.

This article has so much text but so little content. There is no concrete science to back the argument but rather claims and scaremongering. Internet allows us do our own research and come to our own conclusions. The Ketogenic diet has profoundly changed my life to the better. It took me over 20 years to get here though, due to misinformation and reluctance from the indoctrinated to consider the evidence even when the evidence is staring them in the face. Ketogenic diet is not dangerous, however, not necessary for everyone. Even the unnecessary ones that try Ketogenic diet prefer the clarity of mind and the stable energy level it gives them throughout the day. This is a talk held by Dr. Stephen Phinney that got me interested, enough to try it, which I’m for ever grateful for:https://www.youtube.com/watch?v=_evJd_iZZzs

I was able to stop a 7-8 years weed addiction with ketosis and also most of my medical conditions like chest pain, back pain and also my diarrhea that I always had for years, I also drink way less at parties like 2-4 beers instead of ~ 12 so that was the positive for me but ohh boy there was alot of negative (I attribute this with my mind feeling absolutely amazing, the mental clarity, I felt like my intelligence was better)

I started frequently urinating it went on till week 5

On week 4 (1st week of September) I suddenly felt a “shift” down there (imagine a sea-saw, the left part is at its peak then all of a sudden the right side is slowly moving up to the top.. this lasted 1-3 secs)

I woke up the next day, felt great like usual (my brain ALWAYS FELT AMAZING 24/7 but that was it, my brain felt 1,000,000,000% better but everything else was really REALLY bad)

I ate something and BOOM, I started feeling like bacterias were fighting down there then something would go up my urethra and to the tip of my penis then come back in the urethra, moving like that randomly throughout the day.. but the most annoying part was when it just STAYED IN THE URETHRA OMG I FELT MISERABLE!!! My testosterone was LITTERALLY screwed.. I had no sex drive and after 3-4 days it was pushing and pulsing like the testosterone was 10000%

So I tried to fix it.. went from 20g carbs or less to 50,75,100 also calories 1500,1800,1900,2K, 2.2K, etc NOTHING WAS FIXING THIS.

Finally after 1-2 weeks of eating constantly 150+ carbs and feeling bad I was sleeping on Sept 29th I felt that same SHIFT but it was a BRUTAL one, I screamed!! And it lasted 1-3 secs like last time but last shift was very smooth compared to this violent one.

Woke up the next day feeling great like usual in the morning before eating anything.

I ate something and I still have the bacteria fighting feeling but the moving in the urethra thing STOPPED, finally I could live again.

I have been trying to fix my other issue, finally with probiotics and eating raw veggies it seems to be fixing itself , it seems like I had a major gut bacteria imbalance. I went from having extreme diarrhea pre keto to having constipation which this probiotics and raw veggies seems to be fixing now.

My advise: don’t do ketosis .. OR do it for ONLY 3-4 days no exceptions to stop your sugar addiction then come back to normal (yes in 4 days of ketosis I didn’t crave sugar anymore)

I believe I had THYRONAMINES, which caused my T4 hormone to convert into reverse T3 (which started 1st week of September when I got ketosis adapted) .. it was a Bladder/UTI feeling and my hospital ruled most things out like UTI, std etc

I found 2 other people doing ketosis that described the feeling of bladder/uti as well.

On Sept 29th that shift again STOPPED my T4 from producing reverse T3 and was now producing reverse T3… I am now deficient in free T3 which could explain my gut bacteria problem

My TSH hormone was normal so they STOP THERE NO EXCEPTIONS, my hospital refused to test T4 and T3

Dr Shanahan had very few patients with hormone imbalance like me.. and dr cate says he knows it exists but never encountered a problem with his patients because they all did it SLOWLY starting with cutting carbs in breakfast (he has transitionned thousands and thousands of his patients)

When you start producing ketones it feeds your brain and ALL your cells including your colon… Therefore your gut bacteria for carbs starts to die… Once you get OUT of ketosis, you stop feeding your colon because the ketones are no longer there and your gut bacteria that was responsible to feed your colon died during ketosis.. you MUST use probiotics with alot of different strains (start slow like 5-10 billion per day or so) in order to repopulate your gut bacteria… If you experience constipation, anxiety, depression after getting out of ketosis , I can almost wager it’s ur gut bacteria being out of whack.

I am sorry, but your article is way off base. I raised my first child raw/cooked vegan practically with lots of fruit and veggies and his teeth started to decay. And trust me when I say that we did it right. We ate all kinds of nut butters, nuts, seeds, salads, cooked veg, resistant starch, etc,.. every safe plant food we could. The first child never had the option to eat meat, my second child did as i started to eat meat again, after starting to have more of my own issues, then cure from trying to cure my own health issues through a micronutrient loaded vegan/veg diet. My second child never ever wants any vegetables, he would eat certain fruits or starch though selectively, we kind of let them eat whatever was in the house at the time, since they seemed to have a sense about what was good or not for them, as all other natural living creatures do. My second child has not one dental issue. And as soon as we added in meat/bone broths and stopped all fruit/carbs other then resistant his teeth stopped decaying/started healing. So bottom line, there is NO other food source out there that is as nutrient dense or bio-available for the human body. And from being raw/cooked vegan/veg my whole family and I are now into Ketosis, the kids adapt very well and fast. We let them eat whatever foods are in the house, which is now just animal and just no to low carb veggies. My kids did not develop normally either as babies, my wife had stopped eating red meat at 18, then prior to getting pregnant she cut back all meats drastically. Since we did so much juicing/superfoods she got enough nutrition to have healthy kids, but our kids just could not talk/communicate like other kids. They were not suffering with any illness, they were perfectly healthy, but they just would not talk. It was a very mild form of Autism I can say, I would say that it was something similar to EchoLalia, but they wouldn’t even repeat what we said barely. But they were alert/aware of everything at all times and would point or gesture towards what they wanted. We were perplexed to say the least and went to specialists, in an attempt to figure out what was wrong. They were clueless as most of them are, specializing in cluelessness. The magic trick was removing/fruit/all starch and allowing them low to no carb veg with any and all kinds of animal foods. They are now talking, well balanced even happier and healthier kids. We have let them try fruit like a minimal amount still keeping them within Ketosis such as half an apple each child and the affects were not good, they reverted back to their old behaviors and regressed. Fruit is for the birds or the monkeys and is not healthy human food, and definitely not cultivated fruit for sure in my HMO. All plant foods toxins to protect themselves from being eaten, such as phenols, alkaloids, salicylate, etc,… these toxins disrupt gut health/produce leaky gut and while they may kill bacterias, cancer cells, parasites, fungus, viruses, etc,…it does not mean they are healthy for us on a regular consumption basis. We have limited opportunities to eat good meals and if your filling your stomach with fibrous foods loaded with toxins your impeding your own digestion and nutrient absorption. These foods can scar the small intestine and many people cannot digest many plant foods, and they can see them on the other end, so why eat them again? Be smart people, use common sense and stop following all these so called gurus or epidemiologiic studies, they are mostly all flawed and out of balance. Take everything with a grain of salt, I now eat only animal foods as my primary source of nutrition and play around with salads/cooked no to low carb veg, but i find it impedes my meat digestion. Any plant food in any substantial quantity will. If you think the animal food is not enough, then juice lettuce or other no carb veggies, there are many. Drink wheatgrass, use herb spices or edible weeds, which are pound for pound more nutrient dense then almost all store bought cultivated veg. Drink Yerba Mate tea or other plant/weed teas hot or cold your micronutrients, traditional cultures have been doing it that way forever. Drinking your plant micronutrients is the ideal anyway, there’s no digestion involved. Focus on digesting what matters, which is animal foods. The only piece to the puzzle that I/we when it comes to my family have not solved yet, is the need or roll of resistant starch for us. When we ate it, we felt good, but we found ourselves wanting to abuse it by overeating before when we were more LCHF Paleo, so it’s hard to say. I have thought to add it into our diet again now, but how to stay within Ketosis while eating real food RS and not some potato powder is a little tricky, I’m sure we will figure it out as we go along on this healing Journey! So far so good! I love Keto all day long, all day strong energy that is balanced and much more stable then sugar. Yeah it’s an extreme, but what about the SAD diet or the raw vegan or cooked vegan diets? They are all some form of extreme. Watch the Perfect Human Diet and you will find that our closest and nearest relatives ate strictly meat with very little to no plant foods and did just fine as far back as 100,000 years ago. Cultivated fruits/starch/vegetables have been devolving us for the last 10,000 years or so. Well, that’s all i’ve got to say about that!

I have been keto for 2 1/2 years. The only thing I have lost is my diabetes and 130 pounds. Oh and you are correct regarding menstruation…I went through menopause during this time with absolutely no adverse effects. Cholesterol, blood pressure, heart, blood sugars all are perfect, particularly for an over 50 formerly sedentary morbidly obese grandma. Quit spreading lies. Off to the gym now. Keto is my way of life.

Still missing the point. Ketosis is a natural process that does occur during starvation but should be happening all the time anyway. If you don’t eat carbohydrates then you will have to produce ketones. If you eat so much carbohydrate that your body has no choice but to burn them then it will not produce ketones for the brain. It will, instead, force the brain to use glucose for fuel – basically dumping glucose as fast as it can. It is only in recent times (the last 15,000 years) that we have really been ‘carb-centric’ in our eating habits. While this has led to a slow decline in our health because of forcing the ‘glucose burning’ mode on us for most of the time, things have really accelerated in the last 200 years of refined carbohydrates and have started to go through the roof in terms of health decline since we’ve been advising ourselves to eat less saturated fat from animals and more oils from plants, as well as replacing some of the fats with sugars (more carbs).

Most of the so-called ‘adverse effects’ of cutting carbohydrates from the diet are only temporary and can be alleviated by ensuring you keep up with electrolytes as the body flushes water out of the system. These ‘adverse effects’ are no different to the withdrawal symptoms that occur when you take an addict off drugs. Of course you will suffer from lack of concentration and lethargy when your brain suddenly finds itself short of glucose and hasn’t yet adapted to burning fat and converting some of it to ketones for the brain. But, like crack addicts, you will not experience the benefits of being free from the drug unless you persevere with the abstinence.

One issue which has not been discussed in the comments is inborn errors metabolism. Per Medline plus, “Inborn errors of metabolism are rare genetic (inherited) disorders in which the body cannot properly turn food into energy. The disorders are usually caused by defects in specific proteins (enzymes) that help break down (metabolize) parts of food.”

One comment from 2015 mentions it in passing: “Among the pediatric population there are a variety of diseases, including congenital and inborn errors of metabolism, some of which are not compatible with normal survival.”

However, this is inaccurate information (oh, the dangers of relying upon uninformed people on the Internet). While in most cases these disorders are diagnosed in the pediatric population, some of the disorders (there are literally dozens) can manifest later in life, including adulthood. See http://jnnp.bmj.com/content/69/1/5.full or https://www.ncbi.nlm.nih.gov/pubmed/24745891 for more information. In addition, it is important to note for some of these disorders, tests were only developed within the past 20-30 years, and most often the testing is carried out shortly after birth. Lastly, depending on where the person was born can greatly impact how much (or little) testing is performed.

Disorders that can manifest in adulthood include fatty acid oxidation defects. Since the kinetic diet is primarily made up of entirely fat, starting the diet while having an undiagnosed fatty acid oxidation defect could lead to disastrous consequences!

I am actually starting the kinetic diet, but plan on sticking to a 1:1 ratio to see how I respond. In addition, I am having the following baseline tests completed which are geared towards detection of inborn errors of metabolism:

I had been doing keto for about of month and was doing great, but all of the sudden I started getting numbing in my left calf and arm. Then I started getting chest pain on my left side. I kept ignoring it until one day after I got out of the shower and I was feeling really weak, so I went to eat and then I got really nauseous and was dry heaving. My heart started racing and I checked my pulse and it was going 120 bpm. By the time I got to the er my heart was at 140 bpm. They gave me something that lowered my heart rate. They checked for blood clots in my legs and chest and found nothing so they sent me home. I have never experienced this in my life. I still have the chest pain. My blood work showed my globulin high, my CO2 low, AST/GOT high, glucose surprisingly high since I was definitely under 20 carbs a day from veggies only and about 60 grams of protein . My blood work has never shown any problems until now. Plus, my stomach feels so bloated and uncomfortable. I am going to my pcp tomorrow for further testing. I feel like I did something wrong with my electrolytes, but maybe my body just can’t tolerate all the fat.

CONCLUSIONS: KD causes thyroid malfunction and L-thyroxine treatment may be required. This is the first report documenting the effect of KD treatment on thyroid function. Thyroid function should be monitored regularly in epileptic patients treated with KD.

As a nutritionist I really thank you for giving a two sided picture of the story.

I believe that ketogenic diets can be very problematic on the long term and increase the risk of developing colorectal cancer as they can be very low in fibre and high in red meat. Also, they may detrimental for the heart if most of the fat is saturated and very little is mono or polyunsaturated. Of course, it all depends in how they are designed as nutrition is such a diverse field.

Stewart, et al., 2001: “The ketogenic diet has demonstrated good efficacy in children with pharmacologically resistant seizures. Relatively few serious complications have been reported in the more than 70 years in which the diet has been used.”

Kang, et al., 2004: “CONCLUSIONS: Most complications of the KD are transient and can be managed easily with various conservative treatments. However, life-threatening complications should be monitored closely during follow-up.”

Kang, et al., 2005: “Conclusions: The KD is a safe and effective alternative therapy for intractable childhood epilepsy in Korea, although the customary diet contains substantially less fat than traditional Western diets, but life-threatening complications should be monitored closely during follow-up.”

Bank, et al., 2008: States that patients on the ketogenic diet may need monitoring of QT interval by electrocardiography. Also states that, quote, “To our knowledge, there are no previous reports documenting death secondary to QT prolongation among patients on the ketogenic diet for seizure control.”

Suo, et al., 2013: “Conclusions The KD is a safe and efficacious therapy for intractable childhood epilepsy in Chinese children. The influence of age on efficacy is worth further investigation.”

Actually read things your going to cite and make sure they prove your point. Or better yet, don’t HAVE a point when your doing research. As bad as initial bias is, intentional ignorance to things that dispute your opinion is down right inexcusable. I don’t care about this diet one way or the other, but for gods sake, do not spread misinformation. There is enough of that already.

I fear that you haven’t read a pile of other relevant studies proving the opposite and proving that the ketogenic diet is dangerous approach. Have you been paid by the developers of the ketogenic diets. I guess yes, otherwise you would not cite just 4 papers out of >100 other papers proving how dangerous the ketogenic diet is.

Agreed Bill Nye. Someone shared this graphic and made a bunch of negative comments about keto on a facebook thread. I did not agree and so I followed the graphic here and I still find much of this information misleading and quite possibly in my opinion somewhat inaccurate.

I am wondering if the adverse effects are the same for vegans. I have been low carb in the last 6 weeks consuming less than 50 g of carbs on most days, sometimes my net carbs are as low as 20 g. I always exceed my fiber requirement, and my protein and fat choices are not as acidifying as meat and other animal foods.

Just a background. I’m 39 years old, have been vegan since 2007, and vegetarian since 2006. I have been eating a high raw diet since 2006. I tried raw Paleo vegan in 2014 but lasted only 10 days. It’s been hell in my head since I went low carb this year, though my body seems to be fine. I decided to try low carb with the hope of reversing/alleviating traumatic brain injury due to domestic violence.

Dr Adam Nally from keto talk takes every single point you make and counteracts intelligently, we all deal with keto flu but we are all not epilepsy children being starved and consuming shakes instead of real food which almost all the studies you site come from and are 20 years old

I’m interested to know where the information for this pros/cons graphic came from because from the research and information I’ve come across so far does not seem to line up with this information you have presented in the graphic.

While I do not question that these studies show many of the adverse reactions, I would challenge the facts based on the lack of additional supporting studies for “adverse reactions”. Was it the eating pattern or something else?

1) Neurology. 2006 May 9;66(9):1318-24. Use of antiepileptic drugs and risk of fractures: case-control study among patients with epilepsy. Souverein PC1, Webb DJ, Weil JG, Van Staa TP, Egberts AC. Studies show a higher risk of fractures when using of antiepileptic drugs and risk of fractures. In fact, they have twice the risk when compared to larger population studies. 2) Anemia’s occur at 9 x the rate among this population: Epilepsia. 2006 Jul;47(7):1232-6. Risk of aplastic anemia in patients using antiepileptic drugs. Handoko KB1, Souverein PC, van Staa TP, Meyboom RH, Leufkens HG, Egberts TC, van den Bemt PM. 3) The study on Chinese children cited for low platelet counts concluded that KD was safe. Seizure. 2013 Apr;22(3):174-8. doi: 10.1016/j.seizure.2012.11.014. Epub 2012 Dec 28. Efficacy and safety of the ketogenic diet in Chinese children. Suo C1, Liao J, Lu X, Fang K, Hu Y, Chen L, Cao D, Huang T, Li B, Li C. Protein-energy malnutrition (PEM) has been known to cause low platelet counts among other issues. In this article, they also cite hypoproteinaemia among some children. This suggests that the Chinese children were suffering malnutrition. so it possible that their protein levels were too low.

These are just the three that I reviewed since they had the least amount of documentation. Is correct to suggest that these are cause and effect adverse events as you suggest?

This is one of the most poorly written articles on the ketogenic way of eating I have ever come across. Your citations are threadbare, unrealistically weak and barely connect to anything other than epilepsy studies in children with very few participants. There is a plethora of good information on the many pros to the ketogenic lifestyle and you lack credentials, relevancy, experience, and a host of other issues that make you unable to form anything other than a weak, one-sided opinion with few to little anything to back it up. In the extremely widespread ketogenic community, overrun with positive health stories of restored fertility, remission of diabetic symptoms, incredible weight gain, greatly improved cognition, untold numbers of joint pain reduction and other incredible stories, your article is hopefully a place where few shall tread. As with the beginning of any way of eating (never eating cruciferous veggies and suddenly experiencing gastrointestinal distress for example), you can’t make a list of what some experience and tie it in to the untold thousands experiencing incredible, life-changing success with this way of eating. I’ve enjoyed the proven labwork shown by hundreds that, show increased numbers at first (obviously) and then a leveling out and improvement in all areas due to the amazing health benefits gained. Shame on you.

Keto diet has never been properly proven long term to be safe. No indigenous population has ever used Keto nutritional strategy except when starving, including Inuit and Masai. The Inuit actually possess novel adaptations to prevent Ketosis and increase gluconeogenisis. Must have conferred a reproductive advantage.

In a true Paleo setting or pretty much in any natural environment it is not possible to get approx 80% of one’s diet from fat. Your insulin response goes to heck while resting glucose levels go up. Think. Intentional ketosis is the act of fooling the body into thinking it is starving – add too much protein and the body will make carbs. Have a good medical reason to try this, recreational use should be carefully considered first.

This is the best article I’ve read from a critical viewpoint of ketosis. It’s common in critical articles I read to see the author’s ignorance as they make fallacious observations and predictions. It’s sad and weird, especially when I see how many people read and liked a bad article. However, you’ve gotten my attention with an excellent article full of references for me to follow up on. Thanks for doing a good job!

Re: “The dangers of a ketogenic diet was, in fact, the topic of my keynote presentation at Paleo F(x) this year (links to video will be provided once available). ”

It has been two years. I am guessing no video is coming because you were never a presenter, let alone the keynote presenter, at any conference, let alone this one. This article lacks of supporting evidence and screams bias and lack of scientific rigor.

“It follows on from this that the negative effects of the classical ketogenic diet do not result from the ketosis itself but, as detailed above, emerge from the unhealthy and evolutionarily maladapted composition of these diets. Despite their current popularity, coconut oil, olive oil and other vegetable oils labeled as ”healthy” have never been part of our evolutionary diet. The same holds true for flavored yoghurt drinks, sour cream and ketogenic diet formulas (typical components of the ketogenic diets in the published papers). Ketosis as an evolutionarily adapted condition is generally ackowledged among ketogenic diet practicioners. But why not adapt the ketogenic diet in a way that humans were subsisting on for 2.6 million years?”

Log In

Login

Site Footer

Disclaimer: The majority of the links in ThepaleoMom.com posts and sidebar are affiliate program links. This means that (most of the time) when you purchase a product linked from my site, I receive a commission.